the “inn” you speak of is the entire hospital capacity of the United States. What New York City did when their hospitals were overloaded was to evacuate patients to other hospitals within the state and also to surrounding states.
Utilize what you have to work with.
Many decades ago, after Army years, I joined a CAL-ARNG field hospital unit, not quite a MASH. We were prepared for disasters like wildfires, earthquakes, floods, any evacuation or casualty situations, as well as combat, but were quite unsuited for a pandemic. I’ve not kept track so I don’t know if California or any state’s NG can handle plagues.
MrsRico’s mom died negligently in a chain nursing home that we learned, too late, regularly settled wrongful-death suits. The nursing homes I’ve seen - quite a few when I worked a desert ambulance shuttling patients, and more since - are not medical facilities setup to isolate the contagious. Sending COVID sufferers to such care shows desperation.
DSeid, do you have a cite for this?
I work in healthcare with some inpatient work, and as others have said, up until now (meaning even pre-COVID), the focus has been on discharge, discharge, discharge. It can be tricky getting people back to their previous nursing homes once they have been admitted–in my state at least if it’s been a certain number of days since admission, the nursing homes can refuse to take them. So, I can understand the reflex impetus to discharge ASAP, which we know now was the wrong plan.
Let’s start with the very first nursing home case: it was not someone transferred in, it got in from the outside.
The spread is clearly driven to large by the asymptomatic and presymptomatic.
Infectiousness is highest in the day or so before symptoms and falls off rapidly by day seven.
Here’s some on what has been found by contact tracing in nursing homes.
Examples like that are trivially easy to find. Note what is NOT there - cases in which the source tracked to an individual returned from a COVID-19 hospital admission. I can’t find any.
FYI, the Medpage article you linked to showed asymptomatic transmission among residents, not workers.
I’m not saying it’s not possible that the infections are spread by workers, but I’m not seeing any hard data showing that, so saying that the spread appears to be from workers appears premature.
If we are just going to keep speculating, the initial infections may come from workers, but the residents have many more interactions with each other than any individual workers, so it might be that asymptomatic residents are spreading it among themselves.
I’m not saying that’s the case at all, just spit-balling like you did.
I’m sorry but what does WA have to do with NY?.
You’re suggesting an influx of covid patients isn’t a factor in the spread of the disease? By default they are spending 24/7 at these facilities so they represent a much higher degree of exposure then anyone else visiting or working there. And every nursing home I’ve ever been too was filled with the sounds of people who can’t take care of themselves and are constantly coughing.
By default, they are going to spread the disease.
It began with the positive worker was how I read it, but sure could have been the other way.
Sohere.
Given that we know a large number of those infected are asymptomatic or presymptomatic and infectious, pretty sure that even if every individual stayed home when even a little sick it would still have spread.
WA and NY and NJ nursing homes are not all that different from each other.
I simply am not finding cases reported where someone returned from the hospital was the identified source. Meanwhile there are large numbers of workers and residents going around in likely highly contagious phases (compared to someone in a resolving phase) interacting totally unaware of the risk they are to others.
A nursing home patient newly discharged from hospital is going to have a lot more exposure to the people helping him/her to bathe, toilet, dress, take medications, and eat than to residents in another room or floor or wing, whom they may never see face to face.
The experience of the Diamond Princess and other cruise ships indicates that merely being in the same structure isn’t the major concern; once passengers were confined to quarters, the transmission rate plummeted. The major mode of transmission was being face-to-face in hallways and dining rooms and other venues and touching common surfaces. New arrivals from the hospital, however, are very unlikely to be out gallivanting in the halls, or even eating in the main dining room. In most cases, they’re going to be bedridden or nearly so even in the absence of infection control protocols. Meanwhile, the nurses and aides ARE roaming from room to room, touching doorknobs and thermometers, handling trays and carts and wheelchairs, getting up close and personal with multiple patients, and otherwise acting as transmission vectors.
Federal Government Has No Idea How Many Nursing Homes Have Coronavirus Outbreaks
So we have no fucking idea because non-transparency. And we have no fucking idea because all people, dead or alive, aren’t tested. Because our [expletives deleted] national leadership has [political jabs deleted] and more. And expect whatever numbers are produced to be [del]faked[/del] adjusted for improved optics. Sad.
25% of the deaths in NY are from nursing home patients. What is moving from room to room is an airborne virus every hour of every day.
That you’re trying to suggest it’s not from an influx of infected patients is bizarre.
You mean besides the giant stack of bodies?
What is moving from room to room are staff first and foremost and to some degree residents intermingling for needed socialization.
I am repeating some links between threads but -
["researchers at Colorado State University conducting coronavirus testing for workers at nursing homes and other skilled nursing facilities made a series of startling discoveries.
Not only were there a large number of positive results in their test samples, and not only were many of those positives from people who showed no symptoms at all, but the asymptomatic workers were still producing and shedding significant amounts of virus that could go on to infect someone else."](Research at CSU shows why testing only symptomatic people won’t stop coronavirus in Colorado - The Colorado Sun)
“As coronavirus infections increase in nursing homes throughout the state, Santa Clara County made the chilling discovery this month that dozens of staff members with no symptoms of the coronavirus had unknowingly infected the very people they cared for at three facilities experiencing big outbreaks.”
“Infections are probably due to workers being asymptomatic and bringing the virus into long-term care facilities without knowing it, Malcolm said. Some work at multiple facilities and may carry the virus from one to another.”
“FORK UNION (WINA) – The Thomas Jefferson Health District says the majority who tested positive for COVID-19 at a Fluvanna County long-term care facility over the weekend were asymptomatic. TJHD deputy incident commander Ryan McKay says they tested everyone at the Village at Fork Union — staff and patients. He would not say how many positive were patients and how many were staff.”
["For weeks, COVID-19-related deaths and positive cases have been on the rise at nursing homes and elder-care facilities across the state even though those same facilities have been off-limits to visitors since March 15 because of the governor’s executive order. The latest death toll: 577, one in three of all deaths in Florida.
There is little mystery behind what is considered the main culprit in this grim statistic: asymptomatic carriers — many of them long-term care staff members, who are getting tested infrequently or too late. But despite state efforts to ramp up testing, administrators at nursing homes and assisted living facilities told the Miami Herald and Tampa Bay Times it is a piecemeal program that is failing to identify risk and completely contain the virus among the state’s most vulnerable."](State’s COVID-19 testing policy an ‘unmitigated disaster’ for residents of elder homes)
Still can’t find any actual documented cases of a source being a patient returning from the hospital. Still could be one or two that I can’t find. Possible.
There is very little about COVID-19 that I am not willing to hedge on … my main drum beat is that we know too little to making the confident statements so may opine. On this though, the evidence is overwhelmingly clear: the main risk to elders in long term care facilities is from HCWs who don’t know they are infected and contagious, and from residents who are to all appearances with free of SARS-CoV-2 at the time. And this is magnified by the fact that a good number of these workers travel between facilities. The risk posed by a resolving patient, of much less infectivity than someone just about to become symptomatic, handled with the knowledge that they have had COVID-19, is in comparison very very very very very tiny.
again, 25% of NY deaths are from nursing homes and you don’t see a correlation between that number and a process that sends infected people to the homes.
You might as well say distancing has no purpose.
Oh I see a correlation between the number of infected people coming in the homes and new infections. The infected people coming in overwhelmingly are asymptomatic, highly contagious just presymptomatic, and mildly symptomatic workers. I’ve shown the correlation.
Please show the correlation you see between resolving cases coming from hospitals and outbreaks. I can find none.
In Sweden, about half of their deaths have been in nursing homes, and I am unaware of anything remotely similar to New York’s policy/process. To what do you attribute that, if not workers shedding viruses? (Sweden’s nursing homes have forbidden visitors since early March, when the number of cases was under 300 and no deaths had been reported.)
The people most likely to live in a nursing home are the elderly and people with serious comorbidities. The people most likely to die of COVID-19 are the elderly and people with serious comorbidities, regardless of their living arrangements.
Nursing home residents CANNOT distance themselves from the people who come in and out of the facility every day: to wit, the doctors and nurses and aides and therapists and cooks and cleaners and all the rest of the staff. The homes can cancel bingo and close the communal dining hall, but they can’t stop bathing the residents.
You are apparently under the impression that the disease is easily spread through the air to distant rooms, but the evidence that it is airborne is not at all well-established. The best evidence is that the virus spreads most readily to people who are within 3 to 6 feet or who are touching common surfaces.
I refer you once again to the case of the Diamond Princess. Once passengers were confined to their rooms, there are cases of the disease spreading to roommates and to crew members servicing their room, but NOT evidence of widespread transmission through the ventilation systems. There is likely a non-zero risk of that kind of transmission, but the primary mechanism is face-to-face contact within a few feet. Now, exactly how is a patient supposed to maintain social distance from the person wiping their butt?
Washington State got hit early, but had a far lower level of infection in the community; diagnosed cases per million residents is currently barely half the national average (2258 cases and 120 deaths per million in Washington, versus 3993 cases and 238 deaths per million for the US as a whole). Nonetheless, sixty percent of Washington’s deaths have been in nursing homes. What Washington policy do you think caused this death toll?
After 5,000 deaths, state changes nursing home policy
Cuomo is backing off this in a weird, face-saving way. The original regulation remains in place, and nursing homes are still barred from refusing Covid patients. But he’s adding a new regulation on the hospitals, which bars them from releasing Covid patients to nursing homes.
I don’t see your logic here. ISTM that the a primary vector of transmission would be from patient to caregiver to patient. The more infected patients there are in a facility, the more likely that caregivers will pick up these infections and then infect other patients in that facility.
I’ve only skimmed the thread, so I might have missed it. But has the OP ever said which government he’s talking about?
Why would that be a more significant vector than low-paid people in the community, who probably have limited sick leave and strong incentive to show up to work regardless of illness, coming in and bringing the virus with them? CNAs and other aides, e.g., are paid $10-15/hour (the median in my state is $12), and it’s fairly common that part-time employees, of whom there are many, don’t have paid sick leave.
Here in Kansas, several of the first COVID cases identified were in long-term residents of a nursing home in the Kansas City area. Somebody brought the disease to them, and it wasn’t another COVID-positive patient being discharged from hospital because there weren’t any; it about had to be a worker or a visitor, probably no more than mildly symptomatic if anything.
As noted, places that did NOT have a policy of discharging infected patients to nursing homes ended up with rampant infections therein, so it seems logical that the same factors are in play in New York: people with few or no symptoms go to work and shed the virus anyway.
I would think that people who are definitely known to be infected are higher risk than people who might be infected.
Even if CNAs etc. are also at risk of contracting it from the community at large, they are even more at risk if they can contract it both from the community at large and from known infected patients who are given to their care.
At any rate, my specific point in response to your post was that the transmission risk via introducing infected patients to a facility is not (only?) via ventilation systems and the like as you seemed to imply but rather via the very person-to-person caregiver contact that you pointed to as the primary source of transmission.
I’ve seen references to Cuomo so I’m assuming New York state.
My wife’s facility has been temp checking staff since early April when the positive numbers started to get into double digits in our county. They had banned everyone except staff since mid-March. Residents that left the facility for medical treatment (only allowed excursions) were locked into their rooms for 2 weeks upon their return. No common meals or Bingo with the staff. Don’t know the call on the staff member that had an appendectomy this past weekend. Her medical and lifting restrictions may make a quarantine a moot point.