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2020-

2020-07-15 e
Viral-Mediated Euthanasia of the Frail Elderly

Nursing Homes: The Center of the Pandemic

Steven Malanga and Chris Pope join Brian Anderson to discuss how long-term-care facilities have borne the brunt of the Covid-19 pandemic, innovative approaches to nursing-home staffing and training, and what we can learn from the experience to be better prepared next time. (read more and hear audio)

Audio Transcript

Brian Anderson: Welcome to the Manhattan Institute's Eventcast. And thanks very much for joining us. I'm Brian Anderson, the editor of City Journal and today we'll talk about how long term care facilities bore the brunt of the COVID-19 pandemic and what we can learn from that fact. We'll draw upon recent writings on this important issue by City Journal and Manhattan Institute experts. Throughout the program please submit your questions as we go along and I'll try to include them into our discussion. Let me introduce our two panelists first, Steve Malanga. He's the senior editor of City Journal and the George M Yeager fellow at the Manhattan Institute. Writing for City Journal, Steve has pointed to the inadequacies in American nursing homes. Even before the pandemic as Steve notes, the US fell short of protecting the elderly in longterm care facilities from infectious diseases.

Our other guests today is Chris Pope. He's a senior fellow at the Manhattan Institute. Chris's research focuses on healthcare, market regulation, hospitals, entitlement design, insurance market reform. In City Journal, Chris has highlighted successful innovative approaches to staffing during the pandemic that can be a model perhaps for other facilities. So we'll talk a bit about that.

So let me start with you, Steve. The pandemic has proved devastating for nursing homes nationwide. According to some estimates, as much as 40% of the overall count of people who've died in America during the pandemic were nursing home residents. But as you pointed out in a City Journal piece back in April, though this is a horrible and tragic situation, it's also not all that surprising. So what went wrong?

Steve Malanga: Well, first of all, let's talk specifically about the extent of it and where it went wrong. At this point, the best counts are that about 55,000 people may have died in longterm care facilities out of nearly 300,000. It's almost a 20% death rate which is really shocking although again, this is our most vulnerable population probably. To talk about where it's happened, New Jersey is actually led the way. The States with the most deaths in nursing homes are New Jersey, New York, Massachusetts, Pennsylvania, Illinois, California, Connecticut, Michigan.

The States with the highest percentage of deaths in nursing homes, some smaller States, New Hampshire, Rhode Island, Minnesota, Connecticut, and Pennsylvania. We can talk a little bit about some of those States later on. However, here's then the real shocker in 23 States more than half of all deaths have been in longterm term care facilities. Now, the thing is, this was not completely unanticipated by some of us who were writing about early for this reason. Early on, I wrote a piece called the Virus and the Economy, which really attempted to look at what were the health implications of shutting down the economy because I wanted people to try to balance, understand there were health implications to shutting down the economy.

And I wanted them to balance that with the predictions about deaths from COVID, because that's a very easy number to understand. One thing that impressed me while I was doing this, is that a number of health experts, especially epidemiologists were talking early on about those trade offs and they were afraid that a panic was emerging in America. Remember this was mid March I did this. They were afraid there was a panic that was emerging, that was going to make us miss the target. And one prominent researcher said something that stuck with me. He said, "Our focus needs to be on the most vulnerable." He said, "Nursing homes not schools." Immediately after hearing that, I went and started looking at what the record was if you would of nursing homes in terms of infectious diseases. Now, the thing about COVID-19 is it's new, it's unique, but it is basically a respiratory infectious disease and every flu season, we have similar problems with pneumonia and the flu. And I looked at the record in nursing homes. There's a lot of academic research on this and it's pretty startling.

In particular outbreaks are very common. The notion of States mandating protections is very erratic. Only about half of States even require nursing home workers to get a vaccine. We have vaccines for the flu and we're talking so much about how the vaccine is going to save us from COVID but only about half of States require vaccines from nursing home workers. And if you look at it, not even nowhere near 80 to 90% of nursing home residents themselves get vaccinated. You would think that in this vulnerable population that we would be focusing on that and that nursing homes themselves are bringing doctors and make sure this is done or nurse practitioners.

The other thing is there's a lot of criticism of the record on nursing homes in terms of infection controls. In some surveys, 40% of homes during flu season have essentially failed their inspection protocols for infection control. So all of this was very, very troubling. And what then occurred quickly after this, more than anything justified the concerns that we were starting to hear from some of these people like this expert who said again, nursing homes not schools. And yet at the same time, we'll talk about this a little bit more later, what I was hearing from some of the governors was that essentially this COVID was a nobody left behind. (read more and hear audio)

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