Small steps toward a much better world

After mounting criticism and thousands of deaths in New York nursing homes—including several individual facilities that have lost more than 50 residents—the state on Sunday reversed the mandate, which said nursing homes couldn’t refuse to accept patients from hospitals who had been diagnosed with Covid-19. New York now says hospitals can send patients to nursing homes only if they have tested negative for the virus.

Here is the WSJ article, via John F.

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Incredible!

I mean, it's not incredible that this FINALLY happened. It's incredible that Tyler mentioned it.

COVID-19 could just as easily be called the New York Nursing Home Virus, given where the deaths are occurring, and this is 100% directly the fault of the NY State Government.

Calling attention to this fact hurts the Orange Man Bad movement. Kudos to Tyler for actually bringing this up.

He really shouldn't confuse the cargo cult like this.

Cargo cult? You guys stole that as idiots do. The only cargo cult here is the one that thinks you don't wash our hands, don't wear masks, wear guns and wave Trump signs instead, and the virus goes away. Scared away by your masculinity no doubt.

https://twitter.com/KevinVesey/status/1261054854044229635?s=19

Wake up. You are the idiots.

So this is the response to the blithering stupidity of a Democrat governor? I was wondering what idiocy they would drag out of the dregs, and here it is.

You should be ashamed of yourself. What are you, a pension actuary encouraging the killing old people?

You are an idiot too then. Rather than depend best practices you defend partisan idiocy.

"COVID-19 could just as easily be called the New York Nursing Home Virus"

M0r0ns.

I propose "cuomovirus".

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

My only problem with this line of reasoning is that it downplay Chinese culpability, and if we're really honest, the Chinese government holds 80% of the responsibility in this whole thing.

I am old enough to remember when we did not depend on the Communist Chinese for our national security.

We shouldn't now. We made a big mistake with the level of engagement we embraced. In this particular instance, the open border killed us.

The idea was this engagement was supposed to turn them from tyranny and encourage them to be more democratic. Now that that has clearly failed, how about we stop propping up the regime?

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My go-to now is Deep State Hail Mary Fever. Although we know the Chinese don't have any love lost for us, we also know who outsourced research to their lab in the first place, and who has the most to lose at this point in history. It's starting to look an awful lot like treasonous elements in America made this happen as a last-ditch effort to save their hides, and the Chinese were all too happy to help take down their geopolitical rival.

It's fascinating to watch the Flynn revelations come out and fall directly on the cutting room floor, when they are showing there never was any suspicion of Russia collusion, there was just a domestic coup attempt.

Strange days.

For 3.5 years: Russia Russia Russia! Trump has colluded!

This week: "Why is Trump so fixated on Russia? It's a sick perversion with him. Up next, a psychiatrist to explain Trump's fixation and what it means"

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To see Flynn lie in pleading guilty to having lied.

Basically, we can all agree that whether he lied to the FBI, or he lied to a judge by pleading guilty to lying to the FBI, Flynn is a proven liar regardless.

Sounds like he deserved being framed by the government and used as a pawn to get Orange Man, then.

So my question is: what are we going to do to all the "proven liars" who claimed to have hard evidence of ¡RUSSIAN COLLUSION!, the government officials who perpetuated the lie, and the media nitwits who knowingly spread it? My vote is hang them by the neck until dead, although admittedly that's more about the treason than it is the lying.

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Our jails are full of people that didn't do the crime but admitted to doing it. We've had people cleared by DNA evidence that had "confessed," because they realized at some point if they kept stating they didn't do it, they were going away for a lot longer.

Yes, our legal system is broken in that requires some people to lie to get a lesser sentence.

Flynn admitted to a crime that wasn't a crime because the alternative was his son would be put in jail. And now now really terrible people want to hold him to that "confession".

That is effed up beyond words.

As noted by President Trump in a tweet. “I had to fire General Flynn because he lied to the Vice President and the FBI. He has pled guilty to those lies. It is a shame because his actions during the transition were lawful. There was nothing to hide!”

Flynn is simply a liar, unless you don't believe Pence either.

Yes, if someone told me they lied to me, I'd believe them. If they later told me they didn't lie, and they only told me they lied to avoid their child going to prison, I'd feel great pity for the person. I'd not consider them a liar.

We have many people in the mix that have told much greater lies with much greater material impact than Flynn. Remember, he misstated something for which there was a transcript. And the people interviewing him didn't feel he was being deceptive--he just misremembered.

Compare that to all the Obama folks that have gone on TV stating they've seen all this evidence of collusion, and then when asked under oath they reported they've seen zero evidence of collusion.

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Orange Man fired Flynn for lying to the FBI even though we now know the FBI lied when they said Flynn lied to them.

I personally think Trump should fire the FBI.

And, again, the treason in attempting to undo a democratic election because it doesn't serve the interests of the Deep State, we can solve that by hangings.

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Only 23 states report incidence of covid in nursing homes and long term care facilities. Covid rates in those facilities are also associated with local rates outside of them, and the amount of testing in the community, including the nursing home population.

Here is a link which discusses the data issues: https://www.kff.org/coronavirus-covid-19/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/

One of the things I would look at is where the nursing home facility draws its low income workers from. If there is a higher incidence of covid in low income communities, and nursing homes hire predominantly low income workers, I would test whether the vector of transmission is associated with overall covid predominance or very local predominance.

In either case, it doesn't matter: there should have been testing and there was no capacity, until recently, to do so to prevent the transmission.

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Anyone who is not a moron might have checked first and found out that New York actually has the lowest percentage of nursing home deaths of any state in the country.

That's comforting, Cuomo ought to use that when he replaced Gropin' Joe as the sacrificial lamb. "I killed thousands of elderly nursing home patients, but not nearly as efficiently as I killed other New Yorkers!"

Here's a really crazy idea. If you actually have the lowest rate of nursing home deaths, maybe you are a model of success.

Here's an even crazier one. When you have over a quarter of the deaths in the nation, and a significant proportion of cases elsewhere can be traced back to you, you aren't a model of success.

That's a different question, but not a smart response.

What is your answer for "most deaths?"

Aggressive measures to make sure it doesn't happen anywhere else?

My preference would be to build a wall around New York, or failing that, give it to the UN so the WHO can deal with it. At least then the rest of the country wouldn't have to be shut down because cosmopolitan leftists in one city make bad decisions.

Okay, how are you helping America with that stupid reply?

Coronavirus is in every state, and is now growing faster in Illinois than New York.

You mean in Chicago, another leftist shithole. (Funny how that works.) Guess we'll need one more wall then. Tell you what, let's do California while we're at it too.

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Nursing home deaths as a percentage of all deaths is a poor measure of success since you can "succeed" by just killing more people outside of nursing homes. It also doesn't account for what percentage of your population is in nursing homes in the first place. Percentage of people in nursing homes who are dead would be a good measure, and by that measure Cuomo is basically Mao implementing the Great Leap Forward.

Here's the thing though, isn't everyone who criticizes Cuomo here asking for a more open, less restrictive, and higher transmission "plan?"

No, I’m asking that we say 1) thank goodness he changed the practice of forcing Old Folks’ homes to admit sick patients and 2) what the hell was thought behind sticking with this for months?

If this is a smart answer, explain how adding more sick people (without testing, the old demand) would have *reduced* nursing home deaths?

I mean, I'm not sure Tyler got the meaning of this new rule. It's that *negatives* are accepted. That's the same as the old rule, plus testing.

And it sounds pretty reasonable on the surface. If you don't want nursing homes to all become breeding grounds for the virus, you don't send positive or symptomatic patients to all of them.

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-10

This is one of your dumbest walk backs in your commenting history.

Regardless of any policy choice, forcing completely unprepared facilities housing the most vulnerable population to take patients sick with a virulent disease is a massive F up.

Especially as there were empty field hospitals with beds that were so underutilized they began shutting them down

You can't even follow the conversation. I never asked nursing homes to take anyone. I supported designating some to do special care for positive or symptomatic patients.

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March 25:

"On Sunday, during a routine press briefing on coronavirus, Cuomo claimed nursing homes are not forced to care for coronavirus patients, which runs counter to New York’s state guidelines. Cuomo suggested nursing homes call the state Department of Health if they wish to transfer a patient.

“A nursing home can only provide care for a patient who they believe they can provide adequate care for. If they cannot provide adequate care for a patient, they must transfer that patient,” Cuomo said."

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Basically, you guys getting off on a belief opposite to Cuomo's stated plan.

That wasn't the order issued from the Albany. So his press conference didn't match reality.

I'm certainly not 'getting off' on Cuomo sending pandemic patients back to facilities entirely unequipped to handle them.

Anyone who's not a partisan hack should realize this. Compare that to California VA system. Dem vs Dem, that should turn your brain back on since it's not Red vs Blue

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NY had 5600 people die in nursing homes. Florida has 665 people die in nursing homes. Both have a population of 20M. Both had lots of old people. NY had 10X the death rate among elderly as FL.

NYC failed so badly at death in general that it pushed their elder % down. It's hard to understate just how bad NYC was...but it was 2X the death rate (all ages) of places like Spain and Italy. The worst in the world without comparison.

What is clear is that NYC was overwhelmed (100% due to idiotic decisions such as "Ride the subway! Enjoy Lunar New Year! Let's show this virus and Trump we're not racist and we're not scared!"), lots of people died that shouldn't have and wouldn't have if they'd presented to a hospital in Iowa, for example. And thus, the massive death count of NYC has overshadowed the deaths in elder care facilities.

You don't get how horrid this was? You don't get how badly NYC screwed this up?

So let's "open up?"

Here's the thing. There is a smart plan and a stupid plan.

Smart: Other countries drove their infection rates way down, and then opened up. We can do that!

Stupid: Other people are opening up, we should too!

IOW, if NY did keep the subway open too long that is an argument in the opposite direction from which it is now made by the "openers."

Texas has had a death rate lower than those countries you think are smart. Why should they stay closed? Treating the US as a monolith - not smart.

Texas has a higher growth rate than New york. New cases / total cases.

https://twitter.com/prchovanec/status/1261110668637298688

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> IOW, if NY did keep the subway open too long that is an argument in the opposite direction from which it is now made by the "openers."

No, remember closing was to not overwhelm the system. The smartest thing you could do would be to keep the ICU at 80% with all older at risk people sheltered and safe until you had immunity among the under 60 crown.

If everything you accumulated in your life, including home and savings, was draining at 1% per day, would you want to keep sheltering? No? Then you understand the "openers" and their motives. Those that want to remain closed forever are those that are still getting paid, who rely on people getting paid peanuts to keep moving their food.

"Then you understand the "openers" and their motives." Openers should get better jobs and stop whining. Or be better at protecting their assets. I don't want to die or my family to die because of the poor life choices of some.

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Usually one compares the community rate to the community nursing home rate.

Yes, but if you don't look at absolutes, then you lose site of how poorly you did relative to others. NYC failed miserably. They failed especially bad among the nursing home crowd. To now claim the nursing home crowd wasn't so bad because the main population also got really hammered is foolish.

Compared to Florida, NY failed miserably on their nursing homes. Agree?

Read the material I posted from Kaiser Health News. You will learn of the choices that were available on March 30 and how other states were having to do the same thing.

What created a problem on spread was the lack of testing that would have caught the employee transmission problem when the community had a high rate. Also, what compounded it, if you read the March 30 Kaiser News, was that at the time, nursing homes and skilled nursing facilities were dumping on hospitals while they had the capacity, and did, isolate those who contracted covid at their facility.

Go back and look at the history of this. Be objective. Start with the Kaiser Health News article on March 30. Also, don't assume that people when confronted with limited choices don't have to make tradeoffs while also trying to minimize risk.

I did and I have. The power companies didn't have testing capability either. They solve it by closing the power plants and everyone lived there. They didn't see families for months.

That is what you do if testing is available AND you care about those that are defenseless.

Testing doesn't solve this. Testing is too slow. The only thing that stops this is isolation. If something is precious and vulnerable, isolation is your only hope.

The choices were not limited. In hindsight, you must admit if we closed all the borders on Jan 29, and states closed nursing homes that day too (staff lived on site), and then two weeks later we went into lockdown at the state level, the outcomes would have been totally different.

In a pandemic, having your nursing homes staffed by people who are here illegally (and about 1 in 10 nursing home workers are here illegally), with no record of existence, immunizations, scared to report their sickness, etc, is a big, big problem.

If you want to succeed in a pandemic, you must control your borders. MUST.

"and states closed nursing homes that day too (staff lived on site)"

If wishes were horses. Nursing homes, by an large did not have adequate PPE. What really happened at nursing homes is that staff started not showing up. How were you going to legally force staff to live in nursing homes? Assume a can opener is funny to economists, not so much to the rest of us.

Steve

> How were you going to legally force staff to live in nursing homes?

I dunno, how did it happen for our power, sewage, water plants, etc? If you can force 330M to stay inside and watch their net worth evaporate at 1%/day, then you can force others to stay at work and tend critical infrastructure. The former is much worse than the latter. If "every life is precious" then we can readily find people to live on site and tend to people that are guaranteed to not get covid.

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The nursing home situation is especially bad compared to what might have been possible. Overall, California is not so great, about 1,000 deaths in nursing homes, about 1.6% of the nursing home population. But there is a bright spot -- the VA nursing homes in California. Led by an old military doc who has seen AIDS, seen Ebola, and more, the VA acted fast and has had only 2 corona fatalities among 2,100 residents. How come nobody is talking about this?
https://www.latimes.com/california/story/2020-05-10/coronavirus-california-veterans-safe-homes

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Is this the best you got? I'm peanut butter you're glue? How boring. What's the matter, haven't turned on the news yet to get your talking points?

Call me back when you have a point.

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The NY Times actually reported on this fiasco a couple of weeks ago. And next-door in Pennsylvania, the secretary of health in charge of nursing home regulations in the state (which also had the policy of requiring the admission of forcing nursing homes to admin Covid patients with disastrous results) apparently moved her own mother out of a nursing home and into a hotel.

The Pennsylvania Secretary is a he masquerading as a woman. Apparently the same fatal nursing home blunder was made in NJ. In Florida, Governor De Santis, who our media compares unfavorably to the thuggish Cuomo, zeroed in on the vulnerability of the nursing homes. Seems like Democrat governors are prone to incompetence, among other defects.

Actually, over a month ago Dr. Osterholm was urging all nursing homes to be tested. Unfortunately, there were insufficient testing materials, which were limited to those who only had symptoms. States are now beginning to test nursing homes before they test general populations.

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asinine policies, creating more deaths which are then used to justify more lockdown.

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Unfortunately, it's probably too little, too late. Once you've let the virus in the door, so to speak, it will be awfully hard to get it out.

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Amazing

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"the state on Sunday reversed the mandate"

... rather, the dictatorial NY Governor retracted his dangerous edict.

State governors have zero authority to independently make "laws", even if they disgusie them as "executive orders".

The Wisconsinn Supreme Court just declared all this type nonsense to be unconstitutional.

In America, only legislatures can create laws.

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It seems to be common practice. Pennsylvania is dealing with the same thing, what is worse is the person responsible removed their mother and put her in a hotel before sending infected people into the home.

SARS in Toronto was spread by the hospital system by a perverse design, where a patient showed up, was in emerg for hours seen by every nurse and doctor in the emergency ward, then moved to another hospital, spreading it throughout the hospital system by infecting care providers. Italy seems to have been the same thing, scaring the bejesus out of everyone and moving the infection protocol responses up quite a few notches before the virus hit hard. Hospitals have done pretty well.

But this is utter nonsense. 50-80% of the deaths are in care homes. The workers are often immigrants, and as people travelled in their circles brought the virus into the homes. This is a tough problem at the best of times, then you have this blithering stupidity.

Government by pension actuaries.

It is worth reminding oneself that they were moved into the homes by mandate of the Governor himself. This reversal isn't a correction of an oversight by some lowly jackass. This is a reversal of a direct mandate coming from the Governor. Care homes protested, they knew they weren't set up to deal with it, but were ordered directly by the Governor himself.

Meanwhile, the Democratic field is so weak that many have been pitching Cuomo as Biden's replacement, simply because he can construct a sentence.

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Or is this an example of the regulatory state not failing us? Leading to the question where do the those infected with the virus spend their time recovering? In a hospital?

If you read a bit more you will find that this is a reversal of a mandate by the Governor himself where he forced care homes to take infected people overriding their objections.

The focus was on keeping hospitals from being sources of the infection, so much so that he moved the source of infection to the worst place imaginable; into care homes filled with the people the most vulnerable.

A horrible decision that seems to have been replicated in many states.

Maybe we are using different terms? There are retirement communities, at various levels of support for the residents, which can be called called nursing homes. Clearly, sending infectious covid19 patients back into such facilities would be wrong.

However, there are also facilities which are intended for longer term recovery than a hospital. These are also often called nursing homes, but are not intended to be a place for longer term residence, and are generally seen as providing medical support beyond what a retirement nursing home could provide.

The real problem seems to be that even after what happened in Italy and Spain, no one in the U.S. seems to have prepared places that would take infected patients that would still require medical support outside of hospitals.The number of serious cases outweighs deaths by a notable margin in most places, and those cases need to be handled. This is what prompted a hard hit city like Madrid to set up facilities where patients could recover outside of a normal hospital setting. To a major extent since the hospitals had nowhere to put patients anyways.

Regardless of terms, likely we agree that decision making in America regarding this pandemic represents an exceedingly low level of competence.

> no one in the U.S. seems to have prepared places that would take infected patients that would still require medical support outside of hospitals.

More CDC failure. It's like they never actually thought through what would happen in a pandemic.

FWIW, reasonable answers would have been pretty easy. Just commander a (now empty) hotel or a (now empty) school gym + stockpiled cots.

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In my state the hospitals prevailed upon the governor, a Trump ally (protege), to commandeer ambulatory surgery centers (ASCs) and to convert them to ICUs for covid patients. ASCs were mostly closed at the time because they provide what is called elective surgery. ASCs thought it a terrible idea for many reasons, including being infected by covid. The cynic in me thought it was a power play by the hospitals with the help of the governor to rid the hospitals of a pesky competitor (ASCs have taken a lot of business from hospitals). Fortunately CMS intervened and issued an advisory that ASCs should remain covid-free. Most ASCs have re-opened, making another power play by the hospitals and governor much more difficult. Thanks to CMS, a small step to a much better world.

Glad that Florida didn't get hit very hard. Seems NY, PA and Mass would have been served well by having your governor. Isolating covid would have helped them a lot. Maybe Florida is OK with old people while the others are OK with getting rid of them.

I haven't been unhappy with Mass's response. The issue is that we're close to New York and tightly connected economically with NYC. We also had an early super-spreader event at a conference because of travel from Italy.

If NY was mismanaged, we weren't going to escape the fallout.

Florida did especially well given it's older population and its high connectivity to hotspots, though.

> I haven't been unhappy with Mass's response.

You guys didn't close until March 24, and 59% of your deaths came from elder care.

Your first case was on February 1, the second case on March 2. March 6 you had 8. If you had confirmed, you likely had 20 to 80 walking around around with it.

Sorry, but you guys should have shut down around March 6 and you should have taken much more aggressive actions around elder care (no more visitors, suspect sick removed to quarantine areas, health care workers living on site).

That would have been a solid response. Hard to do, no question. But I think any idiot would have closed things down on or around March 24 considering all the big companies were closed AND other states were fully closed by then.

This is mostly fair, but things were shutting down hard in advance of Baker's order. People were reluctant to shut down.

Baker did put less stringent restrictions in quite a bit earlier than that: https://www.masslive.com/coronavirus/2020/03/work-from-home-limit-travel-to-combat-coronavirus-massachusetts-gov-charlie-baker-issues-restrictions-for-public-employees-asks-private-businesses-to-follow-suit.html

The medical response was good though, and included the segregation George insists is impossible, and testing has been easy to get for a while now.

"This is mostly fair, but things were shutting down hard in advance of Baker's order. People were reluctant to shut down."

This is slightly unclear. What happened was people and companies got ahead of the government. My firm basically had us work from home when they were ordered to do so, but most of my co-workers spouses had been working from home for weeks at that point.

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"George insists is impossible"

What was the phrase you used? Oh yeah, "deliberate misreads"

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What Florida needed was as many New Yorkers visiting Florida as New Yorkers living in Connecticut.

+1

This is the Occam’s Razor answer.

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Yeah, no New Yorkers visiting Florida - No one who's ever been to Florida.

That’s an obvious strawman.

It’s called the tri-state area for a reason.

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Our governor in Illinois is a non-entity, and our experience has been poor, but the state that most closely tracks with Illinois is Maryland/DC, and I wonder if the similarities (climate, organic urban hotspots, secondary infections (nastier strain?) from NY, spreading to rural parts of state) swamp different strategies for dealing with the virus.

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rayward, we all remember being told that the health system was going to be bursting at the seams, and that every bit of capacity has to be mobilized. Rewriting history to falsely pitch these measures as some sort of Trump plot just makes you look like a ghoul.

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Disease modelers are wary of
reopening the country. Here’s
how they arrive at their verdict.
To see how their models work, we’ll let you tweak your own. https://www.washingtonpost.com/graphics/2020/health/disease-modeling-coronavirus-cases-reopening/

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Connecticut has had a positive Covid-19 patient in 196/214 care homes.

1200 nursing home residents in CT have died, but Connecticut only has 24000 or so nursing home residents, which means 5% or so of the total nursing home population. Regardless of what the seroprevalence data are showing foe the general population, it is very likely that the attack rate in the 0.6% of the CT population accounting for 50% of the deaths has been much, much higher.

You might think these figures are unusual, but they're similar in every region with a high fatality rate.

Keep this in mind when estimating what the IFR will be once Covid has spread through the entire population. It will almost certainly be *far* lower. Still bad, don't get me wrong, but not as bad as it seems.

That is without even considering nosocomial infections and the elevated fatality rates in those populations.

Yes, Covid causes harm even if you do not die. And yes, it isn't the flu - it wouldnt be the flu even with a similar IFR because it is more contagious. But no, it isn't as bad as you're hearing, or what the excess data suggest to many, even today.

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Of the 5482 deaths so far in Massachusetts, 3338 were from long-term care facilities

https://www.mass.gov/doc/covid-19-dashboard-may-14-2020/download

Canadian seniors are suffering the most from COVID-19, with 79 per cent of all deaths in the country now connected to long-term care and seniors’ homes.

https://www.theglobeandmail.com/politics/article-long-term-care-connected-to-79-per-cent-of-covid-19-deaths-in-canada/

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there are only around 40-45k people in long-term care facilities in Massachusetts, so 7-8% of the total long-term care population in Massachusetts has died from Covid-19.

depending on your assumption for the IFR in that population, that implies an attack rate of 30-40%.

we could have protected them, too. this is scandalous and sad and hard to believe.

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It hurts, just consider in Europe we had identical issues weeks ago, people everywhere should learn from each other...

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So what is a better answer? You have hospitals on the verge of capacity collapse. You have infected patients who are not necessarily in need of intensive care. You have a tsunami coming. So you 'deputize' your nursing homes.

It's a bold decision. Made from the top. it in fact does exactly what "liberate" protestors demand - concentrate the impacts on the elderly. It's a combat leadership decision: someone has to be the first one to fight their way up the hill; who should it be? The leader does not shrink from the obvious political ammunition he leaves on the table for his partisan opportunist opponents to use against him.

What's a better response? I suppose the governor could have taken the Trump approach: ignored the problem, wish it away with magic talk about Lysol, lie about the stats, and DO NOTHING.

Seriously, faced with a Sophie's choice, is it better to make a difficult and controversial command decision, transparently from the top, or is it better to prance around and abdicate in a haze of fantasy and denial?

If there is a third way, can you express it without resorting to an underpants gnome plan whereby the discharged patients magically receive housing and care, provided somewhere that is conveniently not defined, and yet magically does have the capacity?

Hospitals are not, and have not been for the duration of this manufactured crisis, "on the verge of capacity collapse". Most have more capacity than they did previously due to a lack of elective surgery.

As to where they could have gone, how about the hospital ship that left New York only having seen a handful of cases? The field hospital shut down at Javits?

Again, one can tell the cargo cult is confused here. How to blame Orange Man for this? How to spin the deaths of elderly nursing home patients as a good thing? It's all so exhausting.

Utter nonsense. And my point exactly.

We all know that the hospital ship was expressly ordered, by Trump, to not allow infected patients. It was a useless and unhelpful gesture.

It was supposed to off load and segregate the non COVID cases to allow the hospitals to focus on covid and not infect the non COVID cases. It was requested, made available, but was almost unused. They did take a few Covid cases in the end.

But the state did not need space for uninfected cases, the state needed space for infected cases.

And yes, when it became clear the ship was useless, they changed their rule late in the game.

Which underscores my point: the governor's challenge was handling non-critical infected cases.

The obvious answer, obvious because it was done elsewhere, is to have segregated COVID and non-COVID facilities. Sprinkling one or two COVID-19 patients into each facility was the worst possible thing to have done.

Cuomo should lose his job for it.

So it was known at the time that experienced medical facilities would be unable to contain infections of known victims, despite professional precautions?

Perhaps everyone who was infected should have been moved to repurposed event arenas? On a sea of cots on the floor at the Garden perhaps, like some kind of three week hurricane shelter?

That's been known for months. Mass segregated hospitals, much of Canada did too.

Cuomo's move was unbelievably boneheaded, criticized as soon as people knew about it, and took forever for him to fix. Just like the subway.

They needed to declare 5 or 10% of case facilities "COVID-19" facilities and moved the regular patients out of them.

Tyler has declared an obligation to include an analysis of politcal feasibility with all proposals.

How is commandeering the private nursing home system politically feasible?

The hospitals were all over it here. It lowers costs for the vast majority of facilities and lets the ones best prepared specialize.

Cuomo should lose his job.

Ok. I'd like to understand your criteria a little better.

Is advising people on national TV to ingest Lysol a career-ending move?

Troll. If all you've got are misquotes and deliberate misreads, you haven't got much.

Cuomo should lose his job for this.

uh-huh. answer the question or join the trolls.

Have you actually read the quote? That's not what he said.

So no, I don't think it's disqualifying. Troll.

Now he can, since you do not provide it.

Perhaps I'm mistaken, but he seemed to claim familiarity with it.

I find it difficult to believe he'd actually never heard the truth of the matter. I find it a lot easier to believe he was being deliberately obtuse to make his political enemy seem bad. The reason I believe he must have known the truth is because the actual quote is easy to find. The reason I believe he was being deliberately obtuse is because the quote is utterly innocuous.

'innocuous'. I don't think that word means what you think it means...

https://www.nbcnews.com/politics/donald-trump/lysol-manufacturer-warns-against-internal-use-after-trump-comments-n1191586

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Utterly innocuous? Demonstrating, to a global audience, that the president of the United States is not intelligent enough to recognize the idiocy of injecting disinfectant as a cure for a disease? We may have very different definitions of innocuous, considering how strenuously global disinfectant manufacturers and global health authorities warned their customers and citizens to ignore Trump.

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Indeed: inject, not ingest. That's much better. That's totally a reasonable thing for the President of the United States to say.

Yet the maker of Lysol products felt the need to issue a disclaimer to its customers anyway telling them not to ingest or inject it. They probably are TDS trolls over there.

How many people died because of Trump's comments on Lysol? How many people died in nursing homes from COVID-19?

oh drats, you win.

More people died from a global pandemic that the President initially claimed did not exist, or would magically go away on its own, than died from his bad advice about Lysol which led to prompt corrections in the media.

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Actually, if you look into what was being discussed and reported in March, Kaiser Health reported:

"Nowhere are tensions higher than in New York, where Gov. Andrew Cuomo has said 73,000 extra hospital beds will be needed within weeks to treat a surge of COVID-19 patients. Hospitals in the state have 53,000 beds."

Also, nursing home facilities which already had covid residents and capacity to treat them segregated those patients in one area, and were able to accept from outside patients in these segregated portions of their facility.

The other part of the story was that nursing homes were dumping covid patients on hospitals that did not have capacity.:

All of this was happening in March. So, it is interesting to look at what the choices were then and what people were doing because of the crisis and why.

Do some research. Here is an analysis in March of the problem: https://khn.org/news/coronavirus-patients-caught-in-conflict-between-hospital-and-nursing-homes/

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You are absolutely correct, anyone talking about Trump suggesting ingesting disinfectant is clearly misinformed. This is what he said - "And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? So it'd be interesting to check that." Pointing to his head, Mr Trump went on: "I'm not a doctor. But I'm, like, a person that has a good you-know-what."

Please keep correcting people who think Trump was silly enough to suggest ingesting Lysol - and provide the full quote to show how stupid fake news reporting is. Read the transcript.

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How is comandeering the private nursing home system less politically feasible than shutting down the entire country for two months?

It's not even required. The nursing homes would have jumped at this alternative.

Do you have evidence of this willingness?

It took me 15 seconds to find this, based only on the fact that Lord Action said they were doing it in Massachusetts:

https://www.forbes.com/sites/howardgleckman/2020/03/31/states-are-beginning-to-move-covid-19-patients-from-hospitals-to-nursing-facilities/#4531482a4401

Massachusetts has designated 12 nursing facilities to take COVID-19 patients, and the state is beginning to move nursing home residents, starting with 147 in a Worchester facility. And the American Health Care Association, a trade group representing much of the nursing home industry, agrees with these changes, as long as they are managed carefully.

That's in Mass.

The President has directed governors to handle this at a state-by-state level.

What was the willingness in New York?

The American Health Care Association only represents much of the nursing home industry in Massachusetts? Talk about a misnomer.

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Yes, in Massachusetts, when the government moved to designate certain facilities as specialized for handling patients, the industry said "yes, please."

People tend not to say "yes, please do this thing" on their own if you never bother asking them to do the thing. I assume most nursing homes are run on the very edge of competence and it seems every year we find 1 or 2 nursing home turn up a bunch of dead bodies they were hiding. So we need good government oversight and regulation.

On the other hand, we do know the nursing homes in New York were complaining about New York's policies. I knew this just by watching Cuomo's daily briefings, not by reading any conservative media.

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"... by Trump ..."

We know where you're coming from and it's pointless to engage

I'm just engaging with you to tell you I won't be engaging with you.

lol I have a toddler who sharper than you

Enjoy your anonymous raging

are you one of those stunted narcissists or persons on the spectrum who cannot differentiate between people who are enjoying themselves and those who are raging?

you might want to seek professional support for that. you cold start with expressive agnosia.

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Another response trying to excuse this nonsense. You should be ashamed of yourself. This isn't some protester's fault, it was a direct decision by the Democrat governor of a state that led to the deaths of thousands.

If you can't imagine a solution, shut up. I can think of half a dozen. The power of ordering things in a pandemic is almost limitless, and this idiot chose to order the most blitheringly stupid thing imaginable. And you are defending him.

I am not defending him. I am asking the opportunistic partisan cabal in the peanut gallery to offer a better solution.

> . I am asking the opportunistic partisan cabal in the peanut gallery to offer a better solution.

Do what Florida did. Both states are 20M. Florida has 72K in nursing care, NY has 100K. But NY has almost 10X more nursing home deaths than FL.

The obvious answer to your question is: "Ask Desantis what he did to protect the elderly"

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derek,

I think George makes a valid point. When hospitals are overflowing with covid patients, what are the alternative facilities health care capacity (nurses, etc.) you would have used instead.

Post your suggestions below. If you don't have any, then what does that tell you.

Bill, your faux-objective "prove it" schtick works a lot better when you don't butt into a thread full of people talking about what could have been done besides injecting the Wuhan Flu into nursing homes, and it works even better when you don't spout obvious falsehoods like the notion that hospitals anywhere are overflowing.

I posted an article from Kaiser Health News from March 30. https://khn.org/news/coronavirus-patients-caught-in-conflict-between-hospital-and-nursing-homes/

Look at yourself. I provide facts and you seem only to provide rhetoric. Either you are too lazy to find facts, or just like to spew whatever crosses your mind.

You sound like you are afraid of me linking to articles and adding facts. I understand.

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Empty hotels and empty college dormitories could have easily absorbed all infected nursing home patients in New York, especially New York City.

And, they all have nurses and medical equipment and oxygen outlets.

Hotels are used for covid patients displaying mild symptoms. Do some research on skill nursing facilities and how they differ from hotels.

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Nursing homes have almost no built in medical facilities or equipment, they are basically small low end hotels with handicapped bathrooms. Not even hospital beds. The staff has almost zero medical training, and provided most zero medical services (usually only medication supervision, but no IVs for example).

One could have put the discharged from hospital patients into leased motels, or consolidated residents from 5 homes into 4 ( they usually run about 89% full) and had one designated for discharged COVID patients only.

What they did was just stupid.

1. So why did the governor make this unpopular decision, and why did he stick with it so long?

2. Your second suggestion implies the state government directly commandeering private nursing homes and re-allocating their customers?

"1. So why did the governor make this unpopular decision, and why did he stick with it so long?"

Probably the same reason the subway is still open. A desire to look tough and equalize the harm. God forbid someone have a good experience if someone else is having a bad one, so we've got to make all these nursing homes take their share.

Inasmuch as the criticism is coming mainly from the right, I am curious how they square their outrage at the nursing home order with their preferred response being to compartmentalize the pain to the elderly.

And that it be done in a way that does not include overt commandeering private sector operations, which would surely be met with outrage from the right.

The governor's act does that, it does NOT spread the pain. It focuses the pain on the already-infected. It places them in facilities supposedly ready and willing to deal with medical care and infection prevention, and do so at a profit to their investors. Sounds like right wing free market tough love to me.

Same for leaving the subways open. Bold, decisive, allowing people to make their own risk based decision choices. Now the right demands the governor shutdown critical infrastructure?

And his order allows facilities to decide how they want to organize their operations to best fit their own needs.

It's funny that when a Democrat acts like a conservative, all the sudden the snowflakes on the right fall all over themselves with nuance and compassion and calls for commandeering private operations.

The governor's act does that, it does NOT spread the pain. It focuses the pain on the already-infected.

Um. No. It forced facilities with the most vulnerable population staffed by $10/hr Haitians to take patients with a highly virulent pandemic.

Lol, you’re losing it today

Oh, the right cares about immigrant workers and their capacity in low-wage critical jobs now?

Ok, that's good. I pat you on the back for that.

But you must understand this newfound compassion of yours is a little but disorienting.

As I’m not on the right wing, that entire comment is meaningless.

But carry on troll.

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"Inasmuch as the criticism is coming mainly from the right,"

I think this is false. Everyone recognizes this was among the most boneheaded moves made throughout the pandemic. Up there with keeping restaurants in Italy open and fighting the travel ban.

"I am curious how they square their outrage at the nursing home order with their preferred response being to compartmentalize the pain to the elderly."

I'm not onboard with that suggestion, but it is entirely consistent. The idea is that you are okay with differential outcomes due to differential luck. You don't try to make everybody equal.

He's not acting like a conservative. Frankly, he's not really acting like a liberal either. He's acting like someone who isn't thinking things through and is making decisions for emotional reasons..

Okay, there's criticism from two quarters:

Reasonable people who felt like this was a bad decision.

Partisan opportunists who are full of shit and merely using this along with any thing else they can fling to further their obstructionist agenda, and are not above shutting down Republican controlled state houses with armed protestors who don't want to wear masks.

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It would look too much like 'involuntary quarantine.' Maybe even lead to 'sigma.' See yesterday's bizarre discussion on these issues.

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As noted above to derek, there are facilities which are intended for longer term recovery, and they are often enough called nursing homes.

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As even rayward pointed out in his usual fumbled attack on Trump above, there has been plenty of unused hospital capacity. The narrative that there was nothing else to be done with the sick elderly is politically-motivated fakery. Even Cuomo now agrees, as he's rescinded his order.

As others have pointed out, Pennsylvania's state health director put her own parent in a hotel while sentencing others to die.

oh stop, there's plenty of politically motivated fakery to go around.

If there was excess suitable capacity in the hospitals, why didn't the governor use it?

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You don't mix your dry tinder with burning wood unless you want it all to go up in flame.

Find a place to put the covid-positive, but not needing immediate hospital-care, elderly. Hotel rooms? Tent cities? Dedicated nursing homes where you've moved out all non-covid patients? I don't know the best answer, but I know what isn't the wrong answer.

"I don't know the best answer."

Revealing that this drama to be mainly post-hoc opportunistic political noise from the armchair bench-warmers.

A tent city for sick seniors in March. uh-huh. That's some strong optics.

Commandeering the nursing home system. Okay, as if that would not have led to organized right -wing armed demonstrations against the communist oppression.

C'mon folks. Tyler just called in another thread for everyone to scenario-test their proposals against political reality. Commandeering the nursing home system is a non-starter politically. That was not in the governor's option set.

I was listing options. Each had trade-offs. I noticed you skipped "hotel rooms."

Or the field hospitals set up by the National Guard that remained almost entirely empty.

They were sent back to nursing homes instead of the open beds.

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You skipped explaining your understanding of why the governor chose his course.

You also skipped explaining how a hotel room system was a better choice, and feasible. Like I said: no underpant gnomes plans please. Make a case without magical thinking and block box gaps.

Hotels have largely emptied out. There is lots of capacity there.

So into a designated hotel you put the patients who are (1) covid-positive and (2) not in such poor health that they need the constant monitoring that a hospital requires.

If (1) isn't true they go back to the nursing home (after showering and disinfecting their stuff). If (2) isn't true they stay in the hospital.

You hire people to check on them a few times a day and make sure they are fed and not in failing health. These workers need to follow strict health practices, but no worse than would be necessary for workers at the nursing home. And since all the people housed here are covid-positive, the worst case is the worker getting infected, instead of spreading the infection to a super-vulnerable elderly person. They can keep wearing the one same respirator while doing their rounds.

Why did people refuse to do this? Well, at all levels of government, we've seen people who would rather be lazy than try to fix problems. We've also seen apologists who will make up excuses for why their favorite politician chose to do nothing rather than hard work.

On reflection, this is exactly what I proposed in the "voluntary quarantine" thread. If someone is positive, but not really sick, you put them up in a hotel so they don't infect their housemates.

Once you have made that decision for a family of 4, it becomes obvious that you use it for nursing homes.

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Our (currently empty) churches probably would have volunteered to host some, and probably even organized round-the-clock care if necessary.

This kind of stuff in right in their wheelhouses.

Turning to a volunteer informal network of amateurs is a nice, liberal kind of idea. But the essential skills-set was ability to deal with infections and low-level medical care and observation.

Churches are *very* good at the whole "each according to their ability" thing.... and it's not like "low-level medical care and observation" is a particularly high hurdle for an organized group.

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Or grab a (currently empty) university dormitory. As a bonus, dorms already have attached cafeterias.

I'm sure our institutions of higher education would also have been happy to sacrifice a little for the good of society.

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The correct response would be to do what was done for homeless in Seattle. You find a cheap motel, the kind with in-wall AC/heating (no central HVAC) and then you buy the entire hotel for a few months and put the sick in there.

Next, you require the health care staff to live on site of the elder care facility, just as the workers for our utilities did.

Elder care facilities become completely closed systems. Healthy remain, the sick are moved to new places with other sick old people.

Ok, there's obviously a cost component to that. But more importantly, there's the government mandate that workers are conscripted into sequestered service away from their homes to care for people infected with a deadly and poorly understood disease.

Under the requirements of this blog, posters must offer an explanation of how that would be politically feasible. I have not seen anyone comply with that requirement yet.

> Ok, there's obviously a cost component to that.

But that cost comparison pales relative to what we're facing right now. My point is this: In order for a gov to have done a "good" job, they must have closed extremely early (just a few cases confirmed) AND they must have protected the most vulnerable. Had those two thing been done, it would have cut the death toll by a half or more. It's that simple.

And the cost of those two things absolutely pales in comparison to the costs we're facing now.

The country had 20 confirmed cases on March 1, and two week later we had 827. If every gov closed on March 1, then our peak would have been 827 cases (two weeks later) but after that, it would have been declining. And at that point, it would have been easy to contact trace. And that would have avoided the NYC bloodbath too.

Yes I fully agree close hard and early would have been a great strategy.

Alas, at the time of that opportunity, the Federal leadership required to make that possible was yammering about nonsense.

> Federal leadership required to make that possible was yammering about nonsense.

Yes, it was Trump that prevented everyone from closing. The one guy that closed the borders with Wuhan.

Remember, Trump said "I'm the boss of the states" and they argued back (correctly) "No you aren't, we're the boss! We decide everything" and then they decided to show just how big a boss they were by defying Trump and calling him racists.

Dude, please.

somewhere deep in the bowels of the ATF, some guy makes a bad decision about machine guns and the border, and Obama is the worst president ever.

meanwhile, in the face of an epidemic, Trump denies and blames there's even a problem.

please, yourself

> somewhere deep in the bowels of the ATF

And someone if the IRS decided to screw conservative groups, pleads the fifth, and nobody is allowed to ask her if she was given marching orders to do this.

Or, a diplomatic compound in Libya was attacked, ultimately resulting in the in the deaths of several senior officials. We never learn what Obama and Hillary were doing during this time. They won't tell us. All we know is for a many hours US personnel were under assault with no help coming. And in the days and weeks following, the administration insisted it wasn't premeditated (it was) and that it was due to a youtube video (it wasn't).

Or, a president authorizes $2B in mixed currency to Iraq in return for prisoners.

If any of the above happened on Trump's watch, he'd be done. Obama stonewalled them all. His wignman Eric Holder went so far to defy the courts that mandated he turn over information to congress. That was truly obstruction of congress, not like the crap dreamed up when Trump was impeached. That "obstruction of congress" charge didn't even involve the house going to the courts. Because they knew they'd lose.

House goes to courts for info from Holder, courts tell holder to give if over, and Holder says "screw you" is OK.

Housing asking Trump for info, and Trump telling them to "go to the courts, and if they tell me to hand it over, I will" result in impeachment.

Trump was the first to admit there was a problem and take action. Who, prey tell, was the most pro-active Dem in all this? Which dem governor was really moving fast on all this in your estimation? I ask so we can compare their response versus Trump's, day by day.

You won't reply because you have nothing. Zilch.

"And someone if the IRS decided to screw conservative groups, pleads the fifth, and nobody is allowed to ask her if she was given marching orders to do this."

It was the Trump admin that dropped all charges against her. With Trump as part of the deep state it makes it really hard to prosecute people.

Trump settled the lawsuit brought by hundreds of conservative groups against the IRS in 2017. At that time, Trump DECLINED to re-open the case her. He did not close it, it had already been closed. Big, big difference.

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Once again, hundreds of millions of people have been shut in their houses without access to their jobs, etc. for two months now. In what way is this more politically feasible than asking healthcare workers (who have already been "car[ing] for people infected with a deadly and poorly understood disease" on a volunteer basis) to live on-site while doing so?

Re: hundreds of millions of people have been shut in their houses

Where is this true? China maybe? Definitely not in the US. I was outside-- and away from my own house-- twice today, once to bike a bit before starting work and again just now to ride out to Subway to grab lunch.

Is any place in the United States literally shutting people in their houses and not letting them out? I don't think even that control-freak micromanaging governor of Michigan Please back off the use of lurid falsehoods in stating your piece.

> without access to their jobs

That is the operative phrase, which you chose to ignore. If you were losing 1% of your net worth every day, would you be OK with all this? Would you feel good about sheltering in place until it was "safe"?

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I don't see how taking patients that test negative is such a big difference to be honest.

They did not want to manage Active cases, they still don't.

Just the same I did read a story yesterday about an old lady who went through the virus, tested negative, went home and two weeks later went positive again.

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Here is how I would do it. I don't work in that industry, am only as familiar as anyone who has had relatives in these places.

Pandemics trigger legislative emergency powers that are quite impressive. I would get someone to tell me how many care homes in my state. Let's say 300.

I'd get a good manager of people. Probably my political campaign people, they do this for a living. Then drum up 3-400 people who are good at talking on the phone, and have some basic sense. No special knowledge, simply decent good people. There are thousands of them around, many unemployed right now.

Arrange a daily phone call to each facility. Start first with basic information; these places are underfunded, staffed by hard working people with limited experience and knowledge. They are afraid, as afraid as everyone, and don't want to make things worse. They first need information. Get it to them. Today.

That daily call will be the way to communicate information and to get information so that problems can be fixed.

Arrange a list of replacement workers that could fill in. Quickly. Not hard, there are lots of unemployed.

Set up a system where the workers are tracked individually. Not blunt instrument regulator nonsense, simply find out if they could be a vector of the disease by families travelling somewhere. Arrange replacement wages and replacement workers for anyone who might potentially be infected. Recognize that this is likely the most dangerous cause of infection, deal with it. Make it easy and pleasant for everyone involved to cooperate. Make friends with the HR people in these places, be a source of solutions for their problems.

Get people out to the facilities to see if what they hear on the phone represents reality. Don't regulate, arrange resources and assistance to meet the goal.

Set up an emergency infection team to deal with homes that get infections to prevent further spread.

Get families of people in these homes involved. Likely they will be the most helpful, vigorous and knowledgeable.

Oh, get the state regulator of these places involved if they want to be. Tell them that if a home is incapable or unwilling to cooperate, be ready to take over operation.

It isn't rocket science. Models don't help. It is simply detailed management.

Cuomo should be tarred and feathered.

Lowest percentage in the country.

https://www.thecentersquare.com/minnesota/analysis-minnesota-has-highest-percent-of-covid-19-deaths-in-long-term-care-facilities-in/article_1acd0d9e-9608-11ea-8cd2-1f8278e4af2b.html

https://freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70

It's not a very useful metric. Having a big bunch of deaths outside of a nursing home shouldn't improve your ranking.

Was that a smart response?

The real deal here is the pandemic, and the fact that it affects just about anybody.

The lessons of Wuhan and Italy and Spain and New York are that if you let this thing get out of hand it will kill a lot of people.

For some reason the stupid people aren't concentrating on that.

For some reason the really stupid people think the right answer is to not wear masks and just open up

.. while blaming nursing homes and governors.

Japan let the virus get out of control as Tyler pointed out and now the death toll has reached a staggering 710.

France and Britain also have death tolls that aren't much below Italy and Spain.

Where does the myth come from that Japan did not lock down or declare a state of emergency?

"Lifting the state of emergency will mean that prefectural governors no longer have the power to request business closures, but Mr Abe urged the public to be cautious in its return to normality, avoiding large gatherings and working from home where possible."

https://www.ft.com/content/0075415e-1f0e-4600-ba2b-9413d7b7fa0c

Coronavirus was circulating in Japan for several weeks when Abe declared a national emergency, which was not a lockdown, nor were cases/deaths increasing by much to call that.

In Japan, governors were never able to demand businesses shut down but did ask them to be and most complied. There were no fines for those who stayed open.

"Arrange a list of replacement workers that could fill in. Quickly. Not hard, there are lots of unemployed."

Nope, not many people want to work in nursing homes. You would need to up the pay a lot, even with UE high. They you would have the problem of untrained or poorly trained people. They simply wont be ale to follow protocols well. The virus would spread like crazy.

The rest is just a wish list with no way to accomplish any of those. It would take months to accomplish, if it is actually possible. Remember that you are dealing with, by and large, a just above minimum wage work force. They provide very close and intimate care. If you use testing you would need to test daily. Would still miss some people.

Steve

While raising pay to fill nursing home slots might be expensive, is it $2 trillion expensive?

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Only 23 states report covid by nursing homes and long term care facilities.

See data from Kaiser Foundation: https://www.kff.org/coronavirus-covid-19/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/

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Who’s gonna take one for the team and explain to anonymous how fractions work?

Another morning, more cheap shots in opposition to smarter policy.

I don't think you are a Russian sock puppet out to destroy America, but you have to ask yourself .. if you were would you act any different?

This is pretty rich coming from a gal who consistently and eagerly carries water for Chinese collaborators.

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Fractions are now a Russian conspiracy.

Apparently smarter policy is not understanding elementary school math?

top kek Boomer

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> Lowest percentage in the country.

It was low because the normal citizenry was slaughtered by covid in a way they wouldnt' have been if they lived in Iowa. NY states numbers are so bad they make Italy and Spain look competent.

Among those in nursing homes, NY had 10X more die per 100K population than Florida.

NY's low percentage is only because they failed so badly at the basics of keeping those NOT in nursing homes alive.

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What makes it worse is Sonny Cuomo whined and Orange Man bad sent a hospital ship and it wasn’t used for the intended purpose.

How much did that cost?

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Anonymous, whatever handle Prior is using now, George, and Rayward embarrass themselves in this thread. Simply, wow.

Mood: The president of the United States is an imbecile, his fans and defenders are imbeciles, and together they suck too much oxygen out of the room.

They are the reason we cannot have nice things, including an effective pandemic response.

You are all spending too much time being stupid and defending stupidity.

Watching anonymous’s mental and emotional breakdown in real time is pretty amusing.

And to think it’s posted to a public blog for all time.

Turns out he was just feels all the way down.

Go ahead, make a positive case that we have a smart president and he is sponsoring smart policy.

But if you can't do that, don't complain that any citizen is pissed off about it.

Is “smart policy” coming from the experts?

Neil Ferguson is smart.

He was off by a good amount and needed booty calls, but he’ smart.

Is data based on GIGO?

30% unemployment in exchange for my life? But I have a sense of my place in the universe.

It could be this or getting hit by a bus or it’s just my time.

My mother told me many times from the minute we’re born, we’re dying.

I’m a boomer. I grew up with a choice of going by bomb or another way.

I guess that kind of made me realistic.

20 years ago, it could have been ricin on handrails. A nutter with a grudge and explosives.

I’m not going out licking toilet seats, but that was one of the ways they speculated AIDS could be passed at the time. Which is possibly why there are toilet seat covers in the airport.

We will adapt. We did from AIDS.

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Go ahead, make a positive case that we have a smart president and he is sponsoring smart policy.

If you can't do that, you showing up here today to defend idiocy.

You're having an emotional and mental breakdown. The only thing I'm defending in this moment is sanity.

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They embarrass themselves every time they have to actually defend their positions instead of just virtue-signalling. It's what happens when you base your political views on your desire to be considered A Very Smart And Serious Person™ instead of what you can understand.

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Do you qualify as a "libertarian" if you first create a (bad) regulation and then eliminate it?

https://marginalrevolution.com/marginalrevolution/2020/03/governor-cuomo-libertarian.html

State capacity libertarianism is a big tent movement. Or at least a big buffet, where picking and choosing is the appealing highlight.

Buffet? I don’t recommend the bat soufflé tbh

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This is an interesting issue because not all states report covid incidence by nursing home and/or congregate living facilities. Only 23 states do so. Furthermore, the incidence of covid in nursing homes has to be compared to statewide or local incidence of covid. You would expect that if there is high incidence of local covid that employees would be bringing in some disease, just as pork plant workers bring it into their community or bring it into their plant from the community.

Here is a piece from the Kaiser Family Foundation: ur data collection effort finds that in the 23 states that publicly report death data as of April 23, 2020, there have been over 10,000 reported deaths due to COVID-19 in long-term care facilities (including residents and staff), representing 27% of deaths due to COVID-19 in those states. Our data also finds that there have been over 50,000 reported cases, accounting for 11% of coronavirus cases in 29 states. In six states reporting data, deaths in long-term care facilities account for over 50% of all COVID-19 deaths (Delaware, Massachusetts, Oregon, Pennsylvania, Colorado, and Utah; Table 2). High case and death rates may be attributed to a number of factors, including high rates of testing within long-term care facilities and low rates of testing of the general public. The total cases and deaths from reporting states accounts for just over half (53%) of all cases, and 81% of all deaths. Given that not all states are reporting data yet and the continual lag in testing, the counts of cases and deaths are an undercount of the true number of cases and deaths in long-term care facilities."

Here is the link: https://www.kff.org/coronavirus-covid-19/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/

It is important to consider the first sentence of that report:

"COVID-19 has had a disproportionate effect on people who reside or work in long-term care facilities, including the 1.3 million individuals in nursing homes; 800,000 in assisted living facilities; 75,000 in intermediate care facilities; and 3 million people who work in skilled nursing or residential care facilities."

While Kaiser aggregates "residents" and "workers" in these statistics, my reasoned guess is that the vast majority of deaths are attributable to residents. It's not clear if the total population of approximately 2.2 million is for the entire country or just the reporting states, but it appears it is for the country. Although this seems to be a low estimate, these residents represent only about .6 percent of the US population and yet account for a very large percentage of deaths that have been attributed to the virus.

I doubt these dynamics (vastly disproportionate effect on those in elder care homes) are much different than an influenza endemic or pandemic. I don't follow all the US news, but it strikes me that Dr. Fauci and other public health experts should have known this long before the current pandemic hit. Was he (and the others) yelling from the rooftops that our first priority should be to secure the safety of those people?

A month ago, or longer, Dr. Osterholm recommended that states test all nursing home facilities. Unfortunately, there was insufficient testing capacity, which was limited to those who presented with symptoms, rather than employees who showed up at work.

I am glad you read the article and everyone should read the complete article.

I was about to write "Who's Dr. Osterholm"? But, I decided to google it and much to my surprise it is the same Mike Osterholm that I knew in high school! He was a great student and a nice guy. Thanks for the tip.

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I find most notable in the "expert" and political response to this pandemic is the demonstration by the technically expert to project the likely consequences of policies they implement. They see the childish direct action, but are unable, or unwilling, to foresee how their decision will cause other problems.

Our kingdom for someone with experience making operational (real-time, imperfect knowledge, chain reaction) decisions.

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I think the 20th century expansion of nursing homes was a Great Society thing? Big steps to a better world, in other words. Who knew the concentrated elderly would be such a force in the world? But then, did we really need a pandemic to hint to us that nursing homes suck in ways over and beyond how being really old can suck, the more especially when there's no cultural role for you in the life of your family? I remember a few years ago a New Yorker article about an unusual new model for such places, that would take a laissez-faire approach to the final stage of life. You would not have to get up and be dressed and go to the dining room and be spoonfed breakfast. You might just remain abed until noon. You would not have an attendant helping you to move along the hall. You would walk at your own pace, and there would not be strong efforts made to keep you from falling. Or to preserve your life if your heart stopped. Things like that. I wonder if that place is still in business. I think the proprietor thought she was making "small steps" to a better world, but her steps seem in a direction contrary to those which do not question the primacy of nursing homes as they are currently constituted.

I happen to have the world's greatest mother-in-law. Her own mother-in-law was more difficult. Indeed, especially when in drink, she was at times low-key kind of nasty to her, though it was my mother-in-law who kept her integrated into their lives, and not her son, who kept her at arm's length always. When she eventually ran into money troubles and showed up on their doorstep, to live with them, it was of course my mother-in-law on whom this change mostly devolved. And it was she in the deteriorating years to come, who would bring meals up on trays, and deal with diapers and bedsheets; only once, to my knowledge, telling her sedentary, gentleman-scholar husband, I need you to go upstairs to your mother, she made me so upset I almost hit her - I need you to step in for a moment. A moment indelibly burned into her conscience, as one of the most easygoing, kindest women you'll meet with.

I am grateful to her - and in a way to my father-in-law too, as, while he would do none of the work, emotional or practical, isolated with his books, never would it have entered his mind to refuse shelter to his mother, that would have utterly violated his ethical framework - grateful because my small child got to have the somewhat unusual experience of a close relationship with his very-elderly great-grandmother. He adored her, and she him. And I got to know her too, during those years, which was a way into knowing the person I had married, and his family history.

peri,

Before nursing homes, there was what used to be called the "old folks home", which was funded by the county and the local tax base.

We've always have had the elderly with conditions among us. As children moved away from home for a different job, their parents had no one they could move into with.

So, if you don't like nursing homes, open up your basement or attic for your parents to live with you. Otherwise we will continue to concentrate the elderly in facilities.

Your choice.

I just skimmed a short history of this, not sure of the integrity of the source, according to which (basically) there were almshouses of old; then supposedly a different phase involved some segregation into religious or ethnic-based homes for (*our*) aged as well; eventually as institutions were individuated for the "feebleminded," the insane, and so on, the destitute elderly were all that was left in the almshouses. Then supposedly social security was supposed to keep people in their homes, and - initially at least? - was designed not to go to anyone living in a public almshouse, to make them go away. But then they figured out some people went to such places less for financial reasons than for reason of needing nursing care; and then nursing homes like convalescent wards came back into fashion; and then with Medicaid and Medicare paying, there was a great expansion of nursing home beds in America. So the "choice" was not as entirely unmediated as you suggest, perhaps.

The choice was a social choice as well-- because Medicare and Medicaid were voted on by elected representatives. If you want to find an elected representative who would commit to go back to the old way, please have them stand up and be defeated. It is just to say that we have to look at history, as you have done, to understand the choices that are made and why.

Good for you in going over the history of this.

The old folks home or the county home are words that may not be familiar to some, although I don't know if public almshouses is a term used in the US.

This is also interesting from another perspective: we have taken off the shoulders of local communities the business of running old folks homes, and have shifted it to a private model of nursing homes. If there is a failure, it actually might be of the private market. Regulations are unnecessary if the private nursing home is doing its job.

I used the word "regulations" above, but you might want to think about that term when the government is purchasing, directly or indirectly (through pass on payments) for care.

Actually, if you think about it, when the government is the purchaser from a private party, what may be called regulation could also be called "contract specification"--ie, If I am paying for this service, then you must meet these standards. But, we call things regulation==which causes the fur on the back of some people's necks to rise==and instead called it "contract specification for services that are purchased by the government" how much would our attitudes change. And, if we called it "contract specification for goods purchased gy the government" would we be in favor of better contracting terms (notice: I did not use the r word).

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Almshouse, though a perfectly familiar term from books, struck me too, but was the word used in the ten-minute read to which I devoted two. It doesn't have a very Protestant ring. Maybe poorhouse was the American term? I am a little interested in the choices people make, what they believe about those choices and about themselves in making them, whether people tend toward a harder or an easier path, what time may tell about the wisdom of those choices, why choices are so seldom revisited ... not so much interested in the fatty upper layer of elected representatives as stand-ins for the decisionmakers. Just never had the bandwidth for the political side of things. I do not remember the name of my congressperson, and would not trouble him with incoherent rants he/she would not understand. Unless possibly it had to do with public land.

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It's curious, as an outsider, to see the primary reaction of Americans to the pandemic. Rather than treat it as a health emergency, a situation that no-one in the world has had to face before, a situation where many sensible, and sometimes mistaken, paths have been taken, it's become a partisan point-scoring opportunity. The number of people dead is a political football to beat your opponent with. The percentage infected or not is an election statistic.

Wow. Have you all lost your sense of humanity? Those people who died are not just numbers. The doctors, nurses, first responders, grocery store workers, meat plant workers are real people putting their health and well-being on the line. All the people who've lost their jobs are facing real crises.

Maybe it's worth stepping back from scoring points, and instead trying to find ways to work together for solutions that benefit most. Accept that no one side has a monopoly on insight and truth. Holy crap, this crisis has not been a good look for the USA.

+1

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Here's the thing. We can't ask for better from our government because that is a "a partisan point-scoring opportunity. "

We are, to put it mildly, completely fucked.

The only "non-partisan" answer is to accept incompetence and complete lack of a rational national pandemic plan.

At the end of the day, we've done better than a lot of countries. We still don't know a whole lot about the virus, so it's not easy to say what we could have done better, especially considering what we knew at the time of the decisions. For all your yelping about science, the scientists have been all over the board about transmission, reinfections, ect, so how could the politicians know medical science better than the doctors?

We all want to learn from this so there will be a better response to the next outbreak, but if that's a novel virus, some of our lessons learned will work against us - not being applicable to the next outbreak.

Either way, your constant crying about strawman issues does no one any good. You don't seem to be interested in learning anything about the virus itself, but just want to piss and moan about things you don't understand. You are the last one who should be throwing the word 'rational' around.

Remember, I point to countries that did it. They turned around their spread and reduced transmission rates before opening up.

That's what I want.

Well, there’s a published national plan.

Feel free to critique it, I don’t think you’ve even bothered to mention it during your emoting rants.

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> it's become a partisan point-scoring opportunity

That is how the US works now. When Trump closed the border with Wuhan on Jan 29, instead of govs looking at that as an opportunity to get ahead of this, they all dug in and decided they were NOT going to be that guy. So, they went out of their way to tell people to ride the subway, to gather for massive celebrations IN SPITE OF KNOWING THE INFECTION WAS AMONG US.

It's really bordering on insanity in a way I have never seen before. Imagine if Obama was still president and did the exact things Trump did:

1) Closed border with afflicted regions on Jan 29 and declared health emergency that same day
2) Delivered 10X more tests in half the time of our H1N1 response
3) Ensured we didn't run out of beds, ventilators, etc

And then we'd look at states like CA and FL and TX and note that they were collectively larger than Germany and yet had a death rate much, much lower. We'd consider those states successes! States that partnered well with the federal goverment in their repsonse.

And Obama would have thrown NY under the bus becauase the performance was so bad. We'd collectively treat NY as an outlier (2X higher death rate than Spain, nursing home deaths 10X higher than Florida) and furrow our brow and say we need to work harder next time. Cuomo would be done as a leader. DeBlasion would be beaten by an angry mob.

But since Trump is president, we instead celebrate NY has a massive achievement IN SPITE OF TRUMP.

When you hear about Trump Derangement Syndrome, it's this. It causes people to do things they'd otherwise not ever do.

If after Trump closed the entire border on Jan 29 for months, and our govs all closed their states on March 1 (42 known total cases in the US), then two weeks later we'd have 4200 cases we had then, but then it would be the high water mark. It would have been dropping from that point. And contact tracing would have been manageable.

It's really unreal what TDS causes people to do.

Go ahead, make a positive case that we have a smart president and he is sponsoring smart policy.

And don't make the final weak defense that you can't be criticized because that's "point scoring."

...The case is made, we likely have the best President to face this scenario.

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> Go ahead, make a positive case that we have a smart president and he is sponsoring smart policy.

I think that's already been done. Do you seriously believe Pelosi would have closed borders sooner? Do you seriously believe Pelosi would have overridden the CDC and involved the private sector sooner when then CDC was following the same H1N1 playbook that took over 4 months to get to 1M tests?

Give me a clue what a strong dem would have done that would have yielded a different outcome here. Cuomo is the strongest leader you have, and he absolutely botched everything. Late to close work, late to close schools, kept subways open, forced sick people into nursing homes....Do you seriously think HIS decision making would have left the US better off?

Every dem that spoke out said Trump was a fool for closing. And that forced them to defend their position by NOT closing their state.

How foolish is that?

No, that's not a positive case for any plan. That's just a demand that someone play games with counterfactuals, giving you the opening to call any of them impossible.

I will note this. You said:

"If after Trump closed the entire border on Jan 29 for months, and our govs all closed their states on March 1 (42 known total cases in the US), then two weeks later we'd have 4200 cases we had then, but then it would be the high water mark."

Who exactly demanded that all governors close down on March 1st?

What is your fantasy, that they would have just done it spontaneously if they hadn't hated Trump?

No, if that had been the national plan you'd have a good argument. But instead we know what happened. Trump spent those weeks telling us COVID-19 would just go away.

> No, if that had been the national plan you'd have a good argument.

Trump cannot make a national plan. They states have already been clear about that, as is our constitution.

> that they would have just done it spontaneously if they hadn't hated Trump?

But they did do it spontaneously eventually. My question is why didn't they do it earlier? DeBlasio closed schools on March 16. But why not March 5? The answer is because he'd was telling everyone to ride the subway on March 5 "Fears should not keep NY'ers off the subway".

And why not close schools on Feb 26? Because at that time Cuomo was claiming NYC was the "front door" to the world. And why not Feb 9? Because NY gov health officials were calling a "powerful show of defiance of #coronavirus scare"

The difference between them and Trump is that Trump was taking drastic action in the background, while being optimistic in public. That is what you want from a leader.

NY state put in their first order for supplies--masks and hand sanitizer-- on March 6.

Thus, Trump's first action--and it was a massive action bordering on unprecedented--shut down travel was Jan 29 versus Cuomo's first action, which was miniscule--order masks on March 6.

You don't see the difference here?

BTW, note in the timeline how the NYC kept digging themselves in deeper. They start with saying Trump is racist for closing. Then they want parties to celebrate and show their defiance to Trump. Party on! Ride the subway! The world is still welcome! And on an on. And they eventually get to a poitn where they have to pivot. But by then, the damage is done and it's too late.

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"Trump cannot make a national plan."

Nope. This is nothing but a CYA argument. Remember, "Bolton defends decision to shutter NSC pandemic office?"

It was shuttered, and now you pretend it was never a top national priority.

The function of the office and the people in that team moved to other areas working on the same stuff. The team was redundant. Plus, it looked at infections in small, emerging economies where it put boots on the ground to help. China is not small, nor are they emerging. Nor do they welcome our boots on the ground. They barely tolerate the CDC.

Why do come forth with stories that you know are false as if they are big proofs for your cause?

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think this is like watching a Delillo novel

"clappers cnn camera goes black"

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The commenter "George" seems to believe in something analogous to the "Efficient Markets Hypothesis" except for Democratic ran jurisdictions: Call It the "Efficient Government Hypothesis." Anything Cuomo's government did must have been the best decision possible given the information available at the time. To be fair, republican partisans believe the same thing. A free thinker should be able to simultaneously believe that Trump can make stupid decisions and Cuomo can too in the same timeline. Partisans mainly believe one or the other.

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