Sunday, May 10, 2020

Simple arithmetic demonstrates that the epidemic, outside nursing homes, is essentially over

Daniel Horowitz

We are weeks past the peak of coronavirus hospitalizations, yet the reported national death numbers keep rising 2,000 or more every single day. It made no sense to anyone who has followed the curves in any other country, but now we have our answer. The Hartford Courant reported that 90% of all deaths in Connecticut last week were in senior care facilities. This explains why these increased deaths don’t make sense with the reality of empty hospitals in most places.

This revelation should change everything we know about the current state of affairs with coronavirus. Governors are justifying the continued lockdown by pointing to rising deaths, sometimes significantly, in many states and counties. But it now appears, using simple arithmetic, that in most states, the overwhelming majority of deaths are in nursing homes, and in some states and counties, nearly every new death is in a senior facility. And in fact, even in nursing homes, it appears that while numbers are being recorded now, the actual deaths occurred earlier during the peak. Nothing else matters until this fact comes to life.

80%-90% of new deaths, 50%+ total deaths are in senior care facilities

As I reported yesterday, not only do deaths in nursing homes now compose more than 50% (and in some states as high as 80%) of total deaths from the beginning of the entire epidemic, that percentage is sharply increasing in every state day by day. This means that nearly all the new deaths, depending on the state, are occurring in nursing homes.

Every state has a recorded death count that you can track by date, but the recording of the subcategory of nursing home deaths is pretty new in most states, and there is no cumulative tally by date. Nonetheless, using news reports and data from previous dates, we can easily see how many of the new total deaths since then were from nursing homes.

Phil Kerpen has recorded these numbers in his Twitter account, and I have independently verified them by going to each state’s database.

Those are some state numbers of the total nursing home deaths in a respective state’s overall deaths since the beginning of the epidemic. But then you have Virginia, where there have been new recorded nursing home deaths that are higher than the entire total from the past week.

What this demonstrates is that not only are most new deaths occurring in nursing homes, some of them are also being backfilled into the count now that states are beginning to focus on nursing homes as an important demographic data point. This means that depending on the state, either some of the deaths weren’t originally recorded at all during the peak weeks, or they were recorded in the state’s total but because the patient died in a hospital, they weren’t initially listed as a nursing home death, even though the patient came from such a facility.

I’m seeing the same thing in my home state of Maryland. There have been 317 new recorded deaths in Maryland from April 28 through May 6, and 333 from nursing homes! Again, clearly, not only are there few coronavirus deaths outside nursing homes any more, but even some of the nursing home deaths are either being added retroactively to the state’s overall total or having the effect of revising the previously reported non-nursing home subtotal down because they are now researching past hospital deaths of nursing home patients.

For example, in Baltimore County, 124 of 149 total deaths occurred in these facilities. That is 83% of all deaths. But if you tally the numbers since April 29, there are 59 new nursing home deaths, even though the total county deaths only went up by 55.

Different states and counties have varying numbers. In Minnesota, for example, 89 percent of the new deaths recorded on Tuesday were in nursing homes. Some might not be quite as dramatic, but they tell the same story. The curve has long been flattened, the deaths have nearly stopped in most areas of the country outside nursing homes, and even in nursing homes, some of the numbers are being backfilled, and there are serious questions about the data and criteria for coding these deaths.

This is why some counties in Pennsylvania are asking the state to be transparent and separate out nursing home deaths from other deaths per day. They are being told they cannot open up because there are still people dying, but the question of whether the tragedy is largely confined to nursing homes or whether it’s widespread makes a huge difference. Most counties in Pennsylvania are seeing upwards of 80% of deaths occurring in nursing homes in recent days and weeks. The government of Livingston, New Jersey, is making the same request because 80% of all recorded deaths are occurring in long-term care facilities, and the growth of that share of the pie is accelerating every day.

I have checked over 30 states that produce data on nursing home deaths and have found that in each one, the share of deaths that nursing homes compose of the statewide total has dramatically increased to varying degrees over the past 1-3 weeks.

The implication is that there is no excuse whatsoever not to open up the country and throw all our resources at protecting nursing homes. But it also raises questions as to what is going on with the count in nursing homes.

A scary national death tally built on questionable nursing home data

Fox News reported on Tuesday regarding the New York numbers: “Exactly how many nursing home residents have died remains uncertain despite the state’s latest disclosure, as the list doesn’t include nursing home residents who were transferred to hospitals before dying.”

At least during the peak time, that could have been a large number, if not the majority of nursing home deaths. This could shed light on what is going on now. Could it be that the numbers aren’t surging quite as much as the toplines suggest, but that some states are now recording more prior deaths as nursing home deaths? The implication of this would mean that even the states that have less than 50% of deaths recorded from nursing homes, such as New York (it’s about 36%) might wind up all being over 50%. The Washington Post already predicts that more than half of the nation’s total deaths are in nursing homes. That would mean that no more than 36,000 deaths so far were ever from non-nursing home patients and that nearly none of them are now.

Then there is also the issue of reliability of the data. There are concerns overall that too many people who tested positive for COVID-19 but died of “a clear alternate cause,” to quote Illinois Public Health Director Dr. Ngozi Ezike, are being added to the count. However, this concern is magnified now that most of the numbers are coming from nursing homes. We know that once the virus gets into nursing homes, the overwhelming majority, if not all, of residents will test positive for the virus, as we’re seeing in other confined spaces, such as ships and prisons. While it is very deadly and dangerous for them, clearly not all who die in nursing homes are dying of COVID-19. People die fairly suddenly in nursing homes every day, probably more so than anywhere else.

Take New York’s nursing home death data, for example. States and counties began adding “presumptive” deaths to the overall fatality count in recent weeks. But usually the presumptive deaths are only a fraction of the confirmed deaths, and with New York’s overall total deaths, that fact is no different. Now, take a look at these numbers in New York just for nursing home deaths:

Confirmed: 2418

Presumed: 2585

There are actually more presumed deaths than confirmed deaths among the nursing home demographic. That is astounding. It doesn’t take Sherlock Holmes to smell something fishy.

Remember, roughly 20%-24% of all deaths in America every year occur in nursing homes, and studies have shown that most die from dementia (36%), cardiovascular issues (30%), or pulmonary issues (23%). It’s very easy to see how, now that they are testing everyone in these homes, and most are likely testing positive, any typical death would be coded as a COVID-19 death.

Then there is the question of how many nursing home patients are dying now as a result of decisions by governors to force nursing homes to take back patients from hospitals after they tested positive for the virus. We know this had devastating results in the tristate area around New York City, and now Governor Gavin Newsom is doubling down on the same policy in California.

We need transparency

With our entire way of life destroyed because of false arithmetic and false science, what is the CDC doing with the tens of billions of dollars we gave it? At a minimum, they should publish a breakdown every day of the following:

How many nursing home residents died, as distinct from those who died among the general population, along with a state-by-state breakdown.

How many deaths occurred on the day they were recorded vs. how many were backfilled.

How many of the nursing home deaths are confirmed as having died as a result of the virus, as opposed to just having tested positive (like tens of millions of Americans who likely had the virus but didn’t get a severe case).

How many coronavirus patients were admitted straight from hospitals to nursing homes, broken down by state.

The results of any antibody serology tests the CDC has conducted (there’s no way they haven’t, and if they didn’t, that would be criminal) and a full breakdown of the real fatality rate, stratified for each cohort of age, gender, race, and health status. If they don’t have this data, then what is the purpose of throwing tens of billions at them?

A definitive national and state-by-state number of how many of the 72,000+ deaths were in long-term senior care facilities.

The reason we need independent conservative writers like me to investigate what should be the most publicized data ever is because our overlords do not want us to discover what these results would reveal.



Herd immunity

Because of its virulence, wide spread and the many asymptomatic cases it causes, Covid-19 cannot be contained in the long run, and so all countries will eventually reach herd immunity. To think otherwise is naive and dangerous. General lockdown strategies can reduce transmission and death counts in the short term. But this strategy cannot be considered successful until lockdowns are removed without the disease resurging.

The choice we face is stark. One option is to maintain a general lockdown for an unknown amount of time until herd immunity is reached through a future vaccine or until there is a safe and effective treatment. This must be weighed against the detrimental effects that lockdowns have on other health outcomes. The second option is to minimise the number of deaths until herd immunity is achieved through natural infection. Most places are neither preparing for the former nor considering the latter.

The question is not whether to aim for herd immunity as a strategy, because we will all eventually get there. The question is how to minimise casualties until we get there. Since Covid-19 mortality varies greatly by age, this can only be accomplished through age-specific countermeasures. We need to shield older people and other high-risk groups until they are protected by herd immunity.

Among the individuals exposed to Covid-19, people aged in their 70s have roughly twice the mortality of those in their 60s, 10 times the mortality of those in their 50s, 40 times that of those in their 40s, 100 times that of those in their 30s, and 300 times that of those in their 20s. The over-70s have a mortality that is more than 3,000 times higher than children have. For young people, the risk of death is so low that any reduced levels of mortality during the lockdown might not be due to fewer Covid-19 deaths, but due to fewer traffic accidents.

Considering these numbers, people above 60 must be better protected, while restrictions should be loosened on those below 50. Older people who are vulnerable should stay at home. Food should be delivered and they should receive no visitors. Nursing homes should be isolated together with some of the staff until other staff who have acquired immunity can take over. Younger people should go back to work and school without older coworkers and teachers at their sides.

While the appropriate magnitude of countermeasures depends on time and place as it is necessary to avoid hospital overload, the measures should still be age-dependent. This is how we can minimise the number of deaths by the time this terrible pandemic is over.

Among anti-herders, it is popular to compare the current number of Covid-19 deaths by country and as a proportion of the population. Such comparisons are misleading, as they ignore the existence of herd immunity. A country much closer to herd immunity will ultimately do better even if their current death count is somewhat higher. The key statistic is instead the number of deaths per infected. Those data are still elusive, but comparisons and strategies should not be based on misleading data just because the relevant data are unavailable.

While it is not perfect, Sweden has come closest to an age-based strategy by keeping elementary schools, stores and restaurants open, while older people are encouraged to stay at home. Stockholm may become the first place to reach herd immunity, which will protect high-risk groups better than anything else until there is a cure or vaccine.

Herd immunity arrives after a certain still unknown percentage of the population has acquired immunity. Through long-term sustainable social distancing and better hygiene, like not shaking hands, this percentage can be lowered, saving lives. Such practices should be adopted by everyone.

Social distancing that cannot be permanently sustained is a different story. Some people will eventually be infected, and for every young low-risk person avoiding infection, there will ultimately be roughly one additional high-risk older person that is infected, increasing the death count.

Anti-vaxxers do not suffer the consequences of their beliefs, as they are protected by the herd immunity generated by the rest of us. Neither will the anti-herders, many of whom can afford to isolate themselves from Covid-19 until natural herd immunity is achieved by others. It is older and working-class people that disproportionately suffer from the current approach, becoming infected and thereby indirectly protecting much lower-risk college students and young professionals who are working from home.

The current one-size-fits-all lockdown approach is leading to unnecessary deaths. Protecting older people and other high-risk groups will be logistically and politically more difficult than isolating the young by closing schools and universities. But we must change course if we want to reduce suffering and save lives.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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