Anonymous wrote:Maryland just released, for the first time, cases and deaths from COVID in nursing homes. Like I said in the title, 22% of our cases and 50% of our deaths are from nursing homes.

My takeaways:

1. Those places are practically death sentences for old people and need radical changes.

2. We need to exclude those cases and deaths from the numbers as we think about reopening because they are not community spread. We know where they came from and the risk of exposure is to other residents and workers, not the general public. We need a completely different, separate policy response to nursing homes versus the rest of the community.

Outside of nursing homes, Maryland has 15,700 cases—roughly—and about 478 deaths. In MoCo, a county of 1 million people, we have about 2600 cases and 92 deaths outside of nursing homes.

This pandemic looks very different when you exclude nursing homes.

I feel horrible for the people in those places.

All the data is at Coronavirus.maryland.gov.

I disagree with the bolded (but do partially agree with the rest of the sentence about dealing with nursing homes). The thing is, people work at these nursing homes - at notoriously low pay. Those workers are part of the community, have families, second jobs, neighbors, etc that are community exposed via nursing homes. So this could be a huge vector for community spread, and can't just be separated.

Similarly, "dealing" with nursing homes has to account for the daily in and out from nursing homes. People, goods, services (physical therapy, etc).

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Blowing up the global economy (which will cause horrible deaths of starvation, etc by children) to save the elderly is a huge mistake.

It is also misguided and terribly ineffective. There is no way to contain this virus.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Once these folks get a major cold or flu, the nursing homes don't try to treat it or anything. You are forced to use their doctors who do nothing (or have to basically kidnap them to take them to the ER or outside doctor and if you do they don't follow the orders).

They also do a lot of force feeding but its a catch 22 as if they don't force it lots of residents don't eat. But, if it goes down wrong, they get pneumonia and die.

You really cannot take you experience in one nursing home and generalize it to the industry as a whole.

The industry is horrible. That’s a fair generalization. It’s a cesspool.

We looked at many, spoke regularly to the ombudsman. Majority are like that but there are some good ones. Most of the ones that are medicaid use medicaid as an excuse to have less staff, less activities and quality of care saying they are paid less but they bill for "doctor's appointments where the patients don't actually see a doctor and its a 5 minute visit from a nurse and all kids of other things. They had my MIL going to see a mental health therapist when she didn't know who she was, her name or even verbal. How do you do mental heath therapy on someone like that? Huge scam. We tried therapy at an much earlier stage and the therapist terminated with her as she couldn't remember things 5 minutes later. We looked at other ones and none were any better.

Same for both my parents. Death house. Both were glad when it finally ended. It’s a horror show.

Dementia is a horror show. Period.

Anonymous wrote:

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Blowing up the global economy (which will cause horrible deaths of starvation, etc by children) to save the elderly is a huge mistake.

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Once these folks get a major cold or flu, the nursing homes don't try to treat it or anything. You are forced to use their doctors who do nothing (or have to basically kidnap them to take them to the ER or outside doctor and if you do they don't follow the orders).

They also do a lot of force feeding but its a catch 22 as if they don't force it lots of residents don't eat. But, if it goes down wrong, they get pneumonia and die.

You really cannot take you experience in one nursing home and generalize it to the industry as a whole.

The industry is horrible. That’s a fair generalization. It’s a cesspool.

We looked at many, spoke regularly to the ombudsman. Majority are like that but there are some good ones. Most of the ones that are medicaid use medicaid as an excuse to have less staff, less activities and quality of care saying they are paid less but they bill for "doctor's appointments where the patients don't actually see a doctor and its a 5 minute visit from a nurse and all kids of other things. They had my MIL going to see a mental health therapist when she didn't know who she was, her name or even verbal. How do you do mental heath therapy on someone like that? Huge scam. We tried therapy at an much earlier stage and the therapist terminated with her as she couldn't remember things 5 minutes later. We looked at other ones and none were any better.

Same for both my parents. Death house. Both were glad when it finally ended. It’s a horror show.

I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

Not OP but here is the link from Maryland gov site Will be updated each day so you can track changes

https://twitter.com/mdhealthdept/status/1255264944033083393?s=21

OP- can you post the source for those figures?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

If the major cause of spread and fatalities have been identified, what makes more sense? Shut society down and send out unemployment checks to millions? Or use a fraction of those funds to provide long term care facilities with proper PPE and rapid tests to quickly identify and contain new outbreaks?

I'm not trying to sacrifice Grandma, I'm saying maybe we should focus on the door to Grandma's house and not Grandma's entire state to protect her.

Yes, I've been saying this over and over! (And I help care for two elderly parents.) Social distancing does next to nothing to actually help the elderly.

In fact I'd sharpen it to:

I'm saying maybe we should focus on directing resources to the door to Grandma's house and not diverting resources to Grandma's entire state to protect her.

If even a fraction of the $$$ spent on stimulus checks and unemployment had been used for training, PPE, testing and hazard pay for nursing/ elderly care workers, (plus delivery services reserved for the medically vulnerable) that would have actually reduced deaths.

Yes, we are not directing resources where they are most needed by continuing to pretend everyone is equally at risk.

Agreed. We are literally spending trillions of dollars right now as a country, it seems like some directed investment/measures towards nursing homes/assisted living facilities could go a much longer way to actually protect the residents and workers there than blanket shutdowns, like:

1) Require workers to only work at one facility right now and provide adequate pay to compensate.
2) Provide sick leave and continually test workers
3) Provide adequate PPE

It doesn't take much for this disease to spread through a facility once there- you need to assume that some staff members WILL get it and have measures in place to mitigate spread.

These facilities do have quarantine procedures, most of the employees are wearing masks and gloves while interacting with the patients. Most LTCs have banned non-essential visitors from even entering the building. But, remember, that new residents get transferred in from hospital and home situations all the time. The current residents are in generally poor health and do wind up going to/from the hospital to be treated for all sorts of complications.

While the facilities can take precautions to mitigate the risk of spreading the virus, there is no way that they can guarantee that there won't be an outbreak within their facilities. Most of these places are doing the best that they can with an extremely terrible situation. The same can be said for at home care providers. There is no such thing as a risk free environment for these patients.

Anonymous wrote:

Anonymous wrote:
THE VIRUS DOES NOT KILL JUST OLD PEOPLE.
It kills those with medical conditions and the overweight.
It kills random healthy, younger, people.

What if it kills you? Your spouse? Your child?
There are confirmed deaths in every single age category.

I support a very careful opening, naturally, since there is no other economic option, but PLEASE DO NOT BE DISMISSIVE OF THE RISK.

Call your elected representatives to continue to invest in PPE for all, and aid to facilitate contactless technology for all businesses, and INVEST IN MORE TESTS AND TRACING.

Soon we will enter the second phase of the pandemic: opening followed by the second surge. Continue to be very cautious.

In 1-2 years, there will be a vaccine. I hope it works well (vaccines vary in their efficacy). Until then, we cannot count on this pandemic to just fizzle out by itself. We have to learn to live with our new hygiene and physical distancing lifestyle for a while.

It kinda does just kill old people. 90% of Maryland deaths are 60 and older. While I don't think 60 is that old, it is almost exclusively killing older people. 7% are people over 50. So, 3% of the deaths are under 50. We cannot pretend that it doesn't kill predominantly older people. The data is clear.

Agreed. Shouting that the virus just doesn't kill old people is about as relevant as shouting that the flu doesn't just kill old people. Young people have died of the flu too, and based on the antibody data the virus is barely more lethal than the regular flu to the sub 50 population. The media overhypes every younger death but in reality it's incredibly rare. It's about as rare or even rarer than dying in a car accident as a young person. Or a heart attack in an otherwise healthy 40 year old man. Even among older people, the fatality rate is very closely associated with existing health problems. A healthy person in their 70s or 80s without the common comorbidities found in most COVID-19 victims has a very low death rate. The young deaths almost all had existing health problems too.

Anonymous wrote:
THE VIRUS DOES NOT KILL JUST OLD PEOPLE.
It kills those with medical conditions and the overweight.
It kills random healthy, younger, people.

What if it kills you? Your spouse? Your child?
There are confirmed deaths in every single age category.

I support a very careful opening, naturally, since there is no other economic option, but PLEASE DO NOT BE DISMISSIVE OF THE RISK.

Call your elected representatives to continue to invest in PPE for all, and aid to facilitate contactless technology for all businesses, and INVEST IN MORE TESTS AND TRACING.

Soon we will enter the second phase of the pandemic: opening followed by the second surge. Continue to be very cautious.

In 1-2 years, there will be a vaccine. I hope it works well (vaccines vary in their efficacy). Until then, we cannot count on this pandemic to just fizzle out by itself. We have to learn to live with our new hygiene and physical distancing lifestyle for a while.

It kinda does just kill old people. 90% of Maryland deaths are 60 and older. While I don't think 60 is that old, it is almost exclusively killing older people. 7% are people over 50. So, 3% of the deaths are under 50. We cannot pretend that it doesn't kill predominantly older people. The data is clear.

Most of these facilities are managing the care of their very vulnerable residents with as much caution as possible. But there is no way for these care facilities to completely keep COVID-19 away from their residents.

The healthcare workers do their best to exercise caution, but with their residents coming back and forth from other medical facilities, being transferred in from lower care situations a virus can get introduced into the facility pretty easy. Add in the fact, that many of the residents have dementia and aren't always behaving in a rational, reasoned way towards the staff and other residents - that really complicates the situation.

Even in a home environment, the residents are vulnerable to becoming infected because their caregivers are in/out of the house and the person is at risk of infection every time they are taken to a medical facility to see a doctor.

This virus really isn't hitting active, independent over 55 communities like it's hitting actual assisted living facilities and, in particular, nursing homes.

People in nursing homes are there because they need round the clock, hands on nursing. Their bodies are already in a weakened state and their life expectancy is not long.

Obviously, people with serious health issues are back and forth from the hospital and other medical appts (like dialysis, chemo, etc). They are already very sick. When they get exposed to a virus their bodies simply can not fight it off. It's
all a part of being in an end stage condition - any virus can be deadly to them.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

If the major cause of spread and fatalities have been identified, what makes more sense? Shut society down and send out unemployment checks to millions? Or use a fraction of those funds to provide long term care facilities with proper PPE and rapid tests to quickly identify and contain new outbreaks?

I'm not trying to sacrifice Grandma, I'm saying maybe we should focus on the door to Grandma's house and not Grandma's entire state to protect her.

Yes, I've been saying this over and over! (And I help care for two elderly parents.) Social distancing does next to nothing to actually help the elderly.

In fact I'd sharpen it to:

I'm saying maybe we should focus on directing resources to the door to Grandma's house and not diverting resources to Grandma's entire state to protect her.

If even a fraction of the $$$ spent on stimulus checks and unemployment had been used for training, PPE, testing and hazard pay for nursing/ elderly care workers, (plus delivery services reserved for the medically vulnerable) that would have actually reduced deaths.

Yes, we are not directing resources where they are most needed by continuing to pretend everyone is equally at risk.

Agreed. We are literally spending trillions of dollars right now as a country, it seems like some directed investment/measures towards nursing homes/assisted living facilities could go a much longer way to actually protect the residents and workers there than blanket shutdowns, like:

1) Require workers to only work at one facility right now and provide adequate pay to compensate.
2) Provide sick leave and continually test workers
3) Provide adequate PPE

It doesn't take much for this disease to spread through a facility once there- you need to assume that some staff members WILL get it and have measures in place to mitigate spread.

I completely agree with you. And I do see the more sensible political leaders realizing this (like Hogan, who's moving toward opening Maryland gently while focusing resources on nursing homes). And Florida's DeSanti has done this from the get go, focusing state resources and testing on nursing homes.

Just like we changed the entire airport security set up following 9-11 we may need to develop policies for how nursing homes are staffed and run, for at least a few years till the virus is either defeated by vaccination or herd immunity is achieved. I can see the nursing homes becoming something similar to the oilfield camps with resident staff living on the premise in shifts. Four weeks on, two weeks off, extensive testing before allowed to return to work, and so forth. On a rotation basis. It won't be easy but it's something that can be done and will be far more effective than shutting down in some slim hope the virus dies off on its own while we completely destroy the economy in the process.