Examining the COVID-19 Nursing Home Crisis
WM Subcommittee on Health, Examining the COVID-19 Nursing Home Crisis, June 25, 2020
I will not pull any punches.
There is no tax reform attachment, although tax reform could allow employers to operate or co-own nursing homes, which would likely provide better care, in lieu of paying for Medicaid expenses to do so.
This crisis is worse than you think. For whatever reason, the Coronavirus Task Force has ignored the first round of symptoms of this ailment. In my experience, it begins as a cold with heavy product. Bad timing made many sufferers believe that they had merely suffering from hay fever. There is then a week of dormancy. If you assume that exposure occurs two weeks prior to the first symptoms, there are four weeks, rather than two, before SARS symptoms are manifested, including fever, fatigue from low oxygen levels and fatigue from the manufacture of immunity (which feels like a gut punch over a two-week period).
This realization destroys the paradigm behind social distancing, which did not catch the first two weeks of the pandemic. Also, because of the regional spread of the disease, distancing and closure occurred earlier than necessary and is ending just when it is most needed. 22 states should be closing now rather than starting phases one or two of recovery.
On the positive side, our experience is that once one has marked symptoms (other than simply a cold – which is the only symptom younger people likely experience), full immunity is most likely. All of my associates who have been tested after being sick have antibodies and test negative on the RNA virus screen. Neither I, nor they, need to wear protection except for reasons of solidarity. The desire for solidarity, however, is getting a bit thin, especially as those living in fear tend to shun people who admit to having had the virus.
This realization will also allow people who work in hospitals and nursing homes who have been sick to work without personal protective gear (even a mask). The best thing for their patients and residents is to actually be sick or exposed, quarantined for one month, and then return to work at no risk.
Social transmission of the disease is as likely among peers than across generations. Snowbirds are returning and visiting their older friends. One sneeze by one old friend could kill a nursing home. Snowbirds that quarantined in their winter homes likely believe they are not a danger. Disease rates in the Midwest will prove that assumption to be deadly.
For those outside nursing homes, and likely within, the diagnosis of COVID is seen by many as a death sentence. This has become a self-fulfilling prophesy because care is not sought until it is too late. Asthma sufferers actually have an advantage here, because we know and can manage SARS2 symptoms with our current medications. For me, Hydoxyzine, fever reducers and an inhaler were adequate.
Likewise, because heart disease is common among older patients, it may be that cardiac history is not a complicating factor. We will see how high COVID deaths reach in comparison to heart attack death for the year. I suspect the latter will be down and the former may be second to cancer, if not the number one cause of death this year.
If social distancing to date has not worked, it is probably too late for re-imposing it to prevent the rest of the nation from experiencing levels of disease, especially in nursing homes, on the order of those experienced in the State of New York. The death rate there is 150 per 100,00 – or 0.15% of the population. Our calculations are a bit more optimistic at 120 per 100,00 – or 0.12% of the population, with most or all states currently in the exposure phase. If this is the case, the virus should burn itself out by October, with many older citizens, both in and out of nursing homes, being infected.
We predict approximately 400,000 deaths nationwide. We have attached a state by state breakdown based on population. We believe that using the word doomed is essential, given that it is too late to correct the current course. This death rate converts, based on the case to death ratio of 5.6%, to 7 million recorded cases in the next few months. (and many more for those who are never tested but who become ill). The good news, however, is that late distancing makes a rebound unlikely. Everyone who will be infected have likely been exposed, or soon will be.
CDC guidance is inadequate to protect seniors and middle aged adults. It is almost impossible to stop a disease that begins in the same manner as a bad cold. CDC guidance (and proposed guidance for after the pandemic) will make the situation worse, not better.
This virus does not seem to hurt most children and teens, and likely most young adults, because they have colds and are constantly fighting them off. Older citizens are farther away from having colds and being exposed to them. Current precautions also degrade immunity because it is not challenged. This is also why Influenza is so dangerous to nursing home residents. Older citizens who are not in a nursing home, especially those in a multi-generational household, are less likely to become sick, primarily because their immune systems are challenged by their snot-nosed grandchildren.
Any parent will confirm that their younger children are constantly sick and that they share the pain – much to the horror of co-workers – although having sick parents come to work also spreads manageable illness. Being shielded, however, leaves on vulnerable to symptoms. My daughter is with her mother in Knoxville. I got sick. My ex-wife probably will not.
Witnesses should be presented with questions based on our comments. These matters need testing and analysis. Currently, the call for solidarity is social policy, not science. Science looks at what the organization does not want to hear – especially when errors have been made.
I will not pull any punches.
There is no tax reform attachment, although tax reform could allow employers to operate or co-own nursing homes, which would likely provide better care, in lieu of paying for Medicaid expenses to do so.
This crisis is worse than you think. For whatever reason, the Coronavirus Task Force has ignored the first round of symptoms of this ailment. In my experience, it begins as a cold with heavy product. Bad timing made many sufferers believe that they had merely suffering from hay fever. There is then a week of dormancy. If you assume that exposure occurs two weeks prior to the first symptoms, there are four weeks, rather than two, before SARS symptoms are manifested, including fever, fatigue from low oxygen levels and fatigue from the manufacture of immunity (which feels like a gut punch over a two-week period).
This realization destroys the paradigm behind social distancing, which did not catch the first two weeks of the pandemic. Also, because of the regional spread of the disease, distancing and closure occurred earlier than necessary and is ending just when it is most needed. 22 states should be closing now rather than starting phases one or two of recovery.
On the positive side, our experience is that once one has marked symptoms (other than simply a cold – which is the only symptom younger people likely experience), full immunity is most likely. All of my associates who have been tested after being sick have antibodies and test negative on the RNA virus screen. Neither I, nor they, need to wear protection except for reasons of solidarity. The desire for solidarity, however, is getting a bit thin, especially as those living in fear tend to shun people who admit to having had the virus.
This realization will also allow people who work in hospitals and nursing homes who have been sick to work without personal protective gear (even a mask). The best thing for their patients and residents is to actually be sick or exposed, quarantined for one month, and then return to work at no risk.
Social transmission of the disease is as likely among peers than across generations. Snowbirds are returning and visiting their older friends. One sneeze by one old friend could kill a nursing home. Snowbirds that quarantined in their winter homes likely believe they are not a danger. Disease rates in the Midwest will prove that assumption to be deadly.
For those outside nursing homes, and likely within, the diagnosis of COVID is seen by many as a death sentence. This has become a self-fulfilling prophesy because care is not sought until it is too late. Asthma sufferers actually have an advantage here, because we know and can manage SARS2 symptoms with our current medications. For me, Hydoxyzine, fever reducers and an inhaler were adequate.
Likewise, because heart disease is common among older patients, it may be that cardiac history is not a complicating factor. We will see how high COVID deaths reach in comparison to heart attack death for the year. I suspect the latter will be down and the former may be second to cancer, if not the number one cause of death this year.
If social distancing to date has not worked, it is probably too late for re-imposing it to prevent the rest of the nation from experiencing levels of disease, especially in nursing homes, on the order of those experienced in the State of New York. The death rate there is 150 per 100,00 – or 0.15% of the population. Our calculations are a bit more optimistic at 120 per 100,00 – or 0.12% of the population, with most or all states currently in the exposure phase. If this is the case, the virus should burn itself out by October, with many older citizens, both in and out of nursing homes, being infected.
We predict approximately 400,000 deaths nationwide. We have attached a state by state breakdown based on population. We believe that using the word doomed is essential, given that it is too late to correct the current course. This death rate converts, based on the case to death ratio of 5.6%, to 7 million recorded cases in the next few months. (and many more for those who are never tested but who become ill). The good news, however, is that late distancing makes a rebound unlikely. Everyone who will be infected have likely been exposed, or soon will be.
CDC guidance is inadequate to protect seniors and middle aged adults. It is almost impossible to stop a disease that begins in the same manner as a bad cold. CDC guidance (and proposed guidance for after the pandemic) will make the situation worse, not better.
This virus does not seem to hurt most children and teens, and likely most young adults, because they have colds and are constantly fighting them off. Older citizens are farther away from having colds and being exposed to them. Current precautions also degrade immunity because it is not challenged. This is also why Influenza is so dangerous to nursing home residents. Older citizens who are not in a nursing home, especially those in a multi-generational household, are less likely to become sick, primarily because their immune systems are challenged by their snot-nosed grandchildren.
Any parent will confirm that their younger children are constantly sick and that they share the pain – much to the horror of co-workers – although having sick parents come to work also spreads manageable illness. Being shielded, however, leaves on vulnerable to symptoms. My daughter is with her mother in Knoxville. I got sick. My ex-wife probably will not.
Witnesses should be presented with questions based on our comments. These matters need testing and analysis. Currently, the call for solidarity is social policy, not science. Science looks at what the organization does not want to hear – especially when errors have been made.
posted by Michael Bindner at 2:00 PM
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