More interesting data regarding Covid

[+ keroscenefire]

An interesting companion piece that I take as optimistic, despite a somewhat ambiguous headline:

 

The world needs Covid-19 vaccines. It may also be overestimating their power

 

It looks like there are many different vaccines with different approaches and results. I think it's possible we'll see a few different ones come into development. Hopefully they offer some strong protection even if it is just to prevent people from getting dangerously ill.

[+ bigjoey]

I think one thing that may come out of this is an understanding of the importance of infection control. I have talked about the senior facility where I volunteer and how seriously they have always taken infection control to the point of incorporating that into the design of the building as well as the staffing and management.

 

No one seems to notice the 380,000 infection deaths a year from seniors in nursing homes. That number dwarfs the Covid19 number without the hysteria we see in the media. This silent pandemic of nursing home deaths might begin to gain some of the publicity it deserves.

 

If infection control becomes a primary concern, then some of the best practices that I have seen might become part of new regulations. With those new regulations and inspections to enforce them will the infection pandemic end.

[+ stevenkesslar]

I think one thing that may come out of this is an understanding of the importance of infection control. I have talked about the senior facility where I volunteer and how seriously they have always taken infection control to the point of incorporating that into the design of the building as well as the staffing and management.

 

No one seems to notice the 380,000 infection deaths a year from seniors in nursing homes. That number dwarfs the Covid19 number without the hysteria we see in the media. This silent pandemic of nursing home deaths might begin to gain some of the publicity it deserves.

 

If infection control becomes a primary concern, then some of the best practices that I have seen might become part of new regulations. With those new regulations and inspections to enforce them will the infection pandemic end.

 

I agree, but I'd go way further than you.

 

I know you are mainly talking about nursing homes. I completely agree with your point. As you know, infection control was a big nursing home issue before COVID-19. COVID-19 will make it more of an issue for a long time. Even after the crisis is over. So part of the impact of this is it created a huge amount of public awareness and education about infection control.

 

But I think the same thing applies to everyone. Society as a whole. This is NOT the kind of awareness and public education anyone would wish on anyone. That said, it is for sure necessary. And it has already made a huge difference in terms of preventing mass illness and death.

 

I think the leading reason there is a lot less death in any Asian country is simply because there was much deeper public awareness of how bad things could get. Quickly. And what actions were effective to stop an infectious disease. In a sense, South Korea and Taiwan and others were lucky to have to deal with SARS and similar bugs in a way we didn't. Because when something much bigger and more lethal came along, they were prepared for immediate action.

 

Some of those stories I already posted about scientists and modelers talked about discussions they had in March with leaders who said, basically, "You can't shut things down based on a model." They were right. People would have gone nuts. Unless, of course, people knew exactly how bad things could get because the ICUs in New York and Sioux Falls are filled and there's 30,000 dead New Yorkers.

 

I agree with every point made about how kids can't go to school, cancer victims can't get treatment, vaccinations are being missed, etc. But that's all a reason to crush the virus. Having more virus, more hospitalizations, and especially more fear, will not make any of those problems easier. They will make them worse.

 

Scott Atlas just put out another one of his screeds. He uses the word "fear" a lot, which is appropriate. Like people are missing cancer treatments because they are afraid. But it does matter that that what people fear is the VIRUS. So Atlas mostly likes to slam the idea of lock downs. But what he misses is that this is a market lock down. People are avoiding things out of fear. And to some degree ignorance. So public lock downs are basically public ratifications of a market lock down. I think we should be clear that fear and ignorance are the real drivers.

 

I think the chart in this article helps explain why New York has almost 30,000 dead, Massachusetts has about 7500 dead, and Washington has "only" about 1100 dead. The fundamental drivers are fear, ignorance, and public awareness. For most or all of the period from Feb. 20 to March 14th, Massachusetts and New York had ZERO COVID-19 deaths. Washington had their first death in late February, which started a cascade of nursing home deaths there. New York's first death was March 14th. Massachusetts was March 20th. I think that explains what you see in those charts.

 

It was a market lockdown, based on fear, and to some degree ignorance. In late February, when we now know the virus was spreading like crazy, restaurant reservations in Massachusetts were going up. By March 7th, Seattle was already going into a massive market lockdown. New York was starting, but to a much smaller degree. By the following weekend, the entire country was in market lockdown.

 

This was all public fear, and ignorance. Was the fear misplaced? Was the ignorance wrong? Not really, in my view. I think all those restaurant cancellations, which are simply one measure of a much broader market lockdown, are a big part of the reason why a lot fewer people in Washington died.

 

This is completely relevant to what's going on in Georgia and Texas today. To some degree the ranting about government this or that misses the point. The real point is market lockdown. That's what that JP Morgan data I posted is so good with. For the most part, people still won't get on planes and go to restaurants. Because they are afraid. And they are not stupid. They have good reasons to be afraid.

 

This is mostly good news. America in May 2020 is not the same as America in February 2020. Nor is the world the same. It certainly does not mean we beat the virus. But it at least means we are much better prepared. And we won't go down without fighting. Texas is doing a somewhat better job than California. That's a bit embarrassing to me, as a Californian, actually. I mean, yeah, I know they have their viral SWAT teams. But shit! We've got Arnie. Isn't that supposed to be better?

 

 

The thing that makes me sad is that a lot of good people probably think that masks and social distancing are enough. It's a big improvement from late February. Which probably means what happened in late February and early March is not happening now, and won't happen again. Thank God. But my main point is that, as you know from nursing homes, this is complicated. It's a whole bunch of layered steps, that collectively make a huge difference. So more public awareness and more public education is a very good thing. This is why Dr. Fauci and Dr. Birx are national heroes.

 

While we will pay a price on lost cancer treatments and diagnoses and many other things - which is all a good reason to control the virus as soon as we can - there will also be residual benefits for a long time from all this increased public awareness about infection control. Here's one example:

 

COVID-19 Social Distancing Has Mitigated 2020 Flu Season

 

As that chart shows, COVID-19 was late to the flu party this season. But public awareness and the fear-based lockdowns clearly reduced the spread of the flu, too.

 

As bad as 100,000 deaths are, it would have been far worse but for a fearful public that was smart enough to know they were ignorant. So we all went up a steep learning curve as quickly as we could. That is going to make all the difference moving forward. The fear-based market lockdowns were the driver. And they still are. The quicker we build awareness of how to beat this thing, and prove that it actually works, the less fear and market lockdown we'll have.

 

Again, I agree with you. But I think you are underselling public awareness as one of the victories we have already won. We should be very proud of that.

 

To be really optimistic, one of the other things we might learn from this is basic science about infections that might help keep seniors in nursing homes alive. As the risk of being crude, to some degree nursing homes are senior citizen death machines. My Dad said for years about the nursing home his wife was in that this was a place "people go to wait to die". So in many cases COVID-19 simply speeds up the process. My Dad died at the age of 96 of pneumonia, less than a year after he moved into the same nursing home. Had that not happened, he could have easily died there of COVID-19 at 98. I would never argue that is a reason to stop the global economy.

 

What I also never argued is that somehow this was the nursing home's fault. I know you are not saying it is. But I have a deep emotional history with this. There's a wonderful woman named Linda, same name as my sister, who runs the social service dept. in that nursing home. She would tell me she saw my Dad trudging in through the snow every day in the Winter to visit his wife, where he'd drive to from his home a few miles away. She told me she worried about him being alone at home. I did my best to convince him to move into the assisted living facility across the street, where he could have kept his car and had his own room. He just wouldn't. He wanted to live independently as long as he could. On the subject of fear, I can't say he was wrong to fear having to live in a nursing home. Within a year he was dead of pneumonia. But he had congestive heart failure, anyway. Was this in any way the nursing home's fault? That is somewhere I wasn't going to go. Nor did my siblings go there. But every winter there were always lots of deaths from the flu and pneumonia.

 

So some part of that, like you said, is regulation and inspection. That is ongoing anyway, like I ranted about several posts ago with adult foster homes. But there is also a piece that is just about science, and medicine. We are throwing tons of money into research on infectious disease. This is exactly what Bill Gates was begging for.

 

So I'm hoping there will be lots of residual benefits. Helping fight infectious disease in nursing homes could be one of those benefits. At least we can hope.

Edited May 27, 2020 by stevenkesslar

[+ WilliamM]

I think one thing that may come out of this is an understanding of the importance of infection control. I have talked about the senior facility where I volunteer and how seriously they have always taken infection control to the point of incorporating that into the design of the building as well as the staffing and management.

 

No one seems to notice the 380,000 infection deaths a year from seniors in nursing homes. That number dwarfs the Covid19 number without the hysteria we see in the media.

 

President Donald Trump mentioned the hundreds of thousands of flu related deaths each year often during the first six or seven weeks of novel coronavirus pandemic.

[Populist Fury]

IDK how anyone can leave their parents (or grandparents) in one of those "senior facilities". Saddest place for anyone to end up in besides prison ?

[+ keroscenefire]

IDK how anyone can leave their parents (or grandparents) in one of those "senior facilities". Saddest place for anyone to end up in besides prison ?

Because sometimes our parents/grandparents need much more care than can be provided at home. My cousin(s) recently put my aunt in a nursing home. My one cousin works full-time in a very stressful job and my other cousin is basically a fuck-up, barely able to take care of her own kids (she is one of these religious conservatives that doesn't vaccinate her kids and home-schools them as a result..she has been on social services radar more than once). My aunt has dementia and is very willful and stubborn to the point where she would be leaving the house and getting the police called on her. So everyone thought it would be best to put her in a nursing home where she could be monitored more safely.

Edited May 27, 2020 by keroscenefire

[Guest]

IDK how anyone can leave their parents (or grandparents) in one of those "senior facilities". Saddest place for anyone to end up in besides prison ?

I can tell by your insensitive remarks that you've never had to take care of a parent or grandparent with dementia or other serious illness. In her last year, my mother could not be left alone for any amount of time. She could not cook food and was living on yogurt and cold cuts. When she tried to do something in the kitchen, she left the house full of gas. She would wake up terrified in the middle of the night. She could not even figure out the thermostat or the toaster. Even if I were to quit my job and move in with her, no one can provide 24/7 care. The assisted living facility we chose for her was very pleasant and cheerful, with a professional chef running the kitchen. There were scheduled activities every day, parties, and an RN available 24 hours a day. Maybe your parents or grandparents never experienced that, but there are certainly elderly people who end up needing essentially constant care. Unless there is a large number of unemployed family members, "senior facilites," or assisted-living facilities, are usually the best way to go.

[+ bigjoey]

IDK how anyone can leave their parents (or grandparents) in one of those "senior facilities". Saddest place for anyone to end up in besides prison ?

Most moves into “senior facilities” are not moves of choice but moves of necessity.

 

We had to use a bulldozer to get my mother and stepfather to sell the home they loved and move into the independent living section of the “senior facility” where I volunteer. The home was designed specifically for senior living; after six months of living there, my mother told me: “I should have moved here years earlier because life is so much easier.” The good“senior facilities” are physically designed to make senior living easier and programing and services add to making life better.

 

Sorry, but the well run places are far from a “sad” place. The good places add life into those final years. Yes, there are some places that are “sad” but no need to condemn all because of the bad ones. No different than any other aspects of life.

[+ bigjoey]

President Donald Trump mentioned the hundreds of thousands of flu related deaths each year often during the first six or seven weeks of novel coronavirus pandemic.

 

While flu deaths in the entire United States go from about 30,000 to 40,000 per year, the 380,000 per year nursing home deaths from infections cover other infections besides just flu. These deaths get little publicity.

[BgMstr4u]

But shit! We've got Arnie. Isn't that supposed to be better?

Well we had Arnie, but the Governator has left the scene. Newsom has his points, but Arnie was a lot more fun.

[+ stevenkesslar]

Canadian military details horrific conditions in nursing homes battling Covid-19

"The reports they provided us were heartbreaking. They were horrific."

 

I swear to God I want to post something about Germany, which I will. But I'm like a kid in a candy store. I keep seeing other new stories that are relevant.

 

My strong reaction to the article above is this. COVID-19 is going to make everything in nursing homes much worse. Period.

 

These places always have challenges, as the report outlines. Most of what is described in that article are long-term issues. But whatever they are, COVID-19 will multiply and deepen them. The "best practices" places will have more problems and challenges. At the worst places it will invite absolute disaster.

 

To say the same thing with a different emphasis, the only reason to unleash COVID-19 on to a community is to make all the people who work and live in nursing homes in that community miserable. Maybe they are miserable already. But COVID-19 will create more misery. Maybe things are going pretty well. COVID-19 will ensure things go at least somewhat worse.

 

The proof of the pudding is that the report even exists. I am quite sure that in Canada nursing homes are regulated. So I was wondering why the military would issue a report. They were sent in because of staff shortages, which makes sense. And I assume they were shocked, and decided to write a report about it. The fact that any of this happened reinforces my point: COVID-19 is a nightmare for nursing homes. Period.

 

On his thread about the front line @purplekow told a story that is relevant here about staffing. Correct me if I get the details wrong, PK. A senior was admitted with COVID-19. I believe she ended up dying. There were only two people that could have infected her, both of whom were in-home care providers. One had flu-like symptoms, the other didn't. The one who tested positive was the asymptomatic one. As much as I feel sorry that Granny died, I also felt bad for the in-home care provider. I keep thinking of Dr. Birx's grandmother, regretting her whole life that she brought the Spanish flu home from school and it killed her Mom. Some young woman will now know for the rest of her life that she killed someone's Granny, even though she was just trying to take care of her. I would not wish a medical and emotional hell like COVID-19 on my worst enemy.

 

Even if we have ubiquitous and rapid testing, which we don't, figuring out a way to ensure that none of the staff are infected has to be a challenge. I can also see why a lot of low-paid staff wouldn't want to work in these circumstances. It's a bit like being a doctor or a nurse. If COVID-19 gets in, it would quickly expose all the staff to infection, too. My experience is these are mostly very dedicated people. But it's easy to understand why there would be staffing shortages with COVID-19 that would require sending the military in.

 

All of this leads to one inexorable conclusion: keep COVID-19 out. It's that simple. Do whatever it takes to keep it out - if you can. Which means you have to keep it out of the community and state the nursing home is in.

 

I think I can tell you the number of COVID-19 deaths in nursing homes in any state or nation in the world. You tell me how many COVID-19 deaths, and I'll tell you how many were in nursing homes. I'm just going to guess 50 % of the total. And most of the time I'll be in the ballpark. So if you want less deaths in nursing homes, the key variable is this: reduce infection and death in the community around it.

 

Nursing homes linked to up to half of coronavirus deaths in Europe, WHO says

 

A different report with a similar tone and conclusion says its varies from 42 % in Belgium to 57 % in Spain. But no one kept COVID-19 out of nursing homes, or even close. What determines the number of COVID-19 deaths is simply how deep the virus penetrates into the community around it.

 

I'm going to transfer a few points @sniper made on a different thread that nailed it. I hope that's okay sniper.

 

Every single nursing home in the state on NJ has had cases. It's not a matter of whether it's a "decent and acceptable" place. The physical layout makes it impossible to contain until and unless they can do a rapid test of everyone who enters the premises.

 

Also, the places where the nursing home percent of deaths is highest are the ones where people outside are most successful in keeping the rate down. It's to be expected - the nursing home death rate is going to be high in this stage no matter what due to the impossibility of physical distancing, while the death rate outside is heavily influenced by people's behavior.

 

The first statement is just a fact. The second is more debatable, which is what I did on another thread. But I mostly agree.

 

In Washington and Oregon, two of the states that have done a better than average job, I think, of reducing and minimizing community spread, 60 % of the deaths are in nursing homes. The Washington numbers are interesting, expressed as percentages by age:

 

64 % of the cases are worker age (20-59) and 30 % are senior age (60 +)

36 % of the hospitalizations are worker age (20-59) and 63 % are senior age (60+). 26 % of all hospitalizations are patients 40-59. That's significant.

10 % of deaths are worker age (20-59) and 90 % of senior age (60+). Again 9 % of deaths are patients aged 40-59. That's not a minor risk.

 

I think Anders just has this part completely ass backwards. The concept is we'll let the people who can afford to get sick catch COVID-19. It's not worse than the flu, and in Sweden the care is high quality and free. And we'll make sure seniors don't get exposed. That's the idea.

 

Here's the reality. First, for people aged 40-59, it's hardly a picnic. I have to think this is a picture of hell, and unwanted expense, for corporations with middle-aged workers who will spend lots of time in hospital beds - if this hits their factories of offices. But where Anders is just wrong is that somehow this can be kept out of nursing homes. @sniper is right that the seniors in these homes are most likely to get it. They are the sitting ducks. And they will have the worst consequences.

 

@sniper pointed out in his response to my post that in Canada 80 % of all deaths are linked to nursing homes, which is also what the report above says. So if you assume that Canada, like Oregon and Washington, have done a better than average job of reducing community spread, it follows that they'll have a particularly high percentage of nursing home deaths. Seniors are the sitting ducks.

 

Thankfully, percentages are percentages. So in real numbers Washington has 1093 deaths and Oregon has 148 deaths. You can figure out what 60 percent of those numbers are. That number is far lower than the 5000 or so deaths in nursing homes in New York City alone. All roads lead AWAY from nursing homes. If you don't want COVID-19 in nursing homes, you don't want this in the surrounding community.

 

It is easy to blame this on nursing homes that are death traps. And it is fair. One function of even the best homes is to be a deathtrap, where very old and very sick people go to die. That is basically what happened to my Mom and Dad, who I loved deeply and miss a lot. That said, some of these places just suck. They deserve to be attacked, like this report does.

 

But to repeat the crux of a different rant, I wrote a report like the one above - albeit on adult foster homes in Oregon, not nursing homes in Canada. I worked closely with the woman who ran the agency that regulated those homes. I got my view from her: the vast majority of these homes are staffed by dedicated people who do a good job.

 

There were reports for every inspection of every home. Every violation of standards and resulting penalty was cited. So I could tell state legislators that the adult son of this owner raped patients, and that Romanian family slaughtered pigs in the back yard. It was all written up in reports by inspectors that also did a good job, I think. Rape and slaughtering pigs and insect infestations are definitely the details that got me the momentum I wanted, both with media and legislators. I went after a "Dirty Dozen" out of maybe 1000 adult foster homes at the time. But I could not have named a "Horrible One Hundred". There were just not that many that were that bad. The goal was to make it easier to eliminate a small number of bad apples.

 

So I fully agree with you @bigjoey that there are bad apples. And I commend you for your great volunteer work. But with COVID-19 this is not primarily about seniors dying because of a few bad homes. Even though there are definitely a few bad homes.

 

This about seniors dying because of a virus that is a perfect senior citizen killing machine. COVID-19 is going to make staffing and running homes more difficult for even the best homes with the best practices. And the deeper it gets into any community, the more likely it will eventually find a way to get over the wall into a nursing home. The easiest way is probably by going through an asymptomatic staff person.

Edited May 27, 2020 by stevenkesslar

[RealAvalon]

Snarky alternative hypothesis: election is over in November, regardless of outcome, and it’s all over.

 

It’s also interesting to see folks who normally lambast Sweden as a socialist dystopia hold it up now as a paradigm for the world.

 

Hypocrisy- n.the practice of claiming to have moral standards or beliefs to which one's own behavior does not conform; pretense.

And misrepresenting what's going and why, while they are doing it.

[+ sniper]

My employer at one time offered long-term care group coverage. The person who came to talk gave us a lot of interesting snippets. At the time(this was about ten years ago) the average nursing home stay was a bit under 3 years. However, that masked two large sub-populations with very different averages. If you were there for Alzheimer's or the like, your average stay was over eleven years. If you were there for almost any other reason, your average stay was under a year. Partly because when it's not dementia, either the patient fights the move or the family isn't willing to acknowledge the need until things have gotten pretty bad. So...there probably is something to the notion that many of the nursing home fatalities were truly not long for this world anyway. But it's still a horrific way to go and to be avoided.

[+ bigjoey]

My employer at one time offered long-term care group coverage. The person who came to talk gave us a lot of interesting snippets. At the time(this was about ten years ago) the average nursing home stay was a bit under 3 years. However, that masked two large sub-populations with very different averages. If you were there for Alzheimer's or the like, your average stay was over eleven years. If you were there for almost any other reason, your average stay was under a year. Partly because when it's not dementia, either the patient fights the move or the family isn't willing to acknowledge the need until things have gotten pretty bad. So...there probably is something to the notion that many of the nursing home fatalities were truly not long for this world anyway. But it's still a horrific way to go and to be avoided.

I was told that one of the reasons Alzheimer’s residents live so long is they have no stress once they get to a certain point. They are certainly there for a very long time. Where I volunteer, there is a separate building for “memory care” with three levels of functioning with the lowest being skilled nursing.

 

Those who are there under a year are really in two groups:

1-often there until rehabilitation gets them well enough to leave to assisted living or even back home for full independent living.

2-they are pretty well gone and really getting hospice care (where I volunteer there are dedicated hospice beds for “end-of-life care”).

 

The third group who might be there more than a year requires more care than one can normally get in assisted living.

 

The ideal model senior facility is a full continuum of care from fully independent living to end of life care with heavy medical needs (but short of hospitalization/ICU).

 

Interestingly enough, in a continuum of care model, residents move back and forth across the units. For example, a resident in full independent living falls and breaks a hip which sends her for a short hospital stay; she is then discharged to the skilled nursing section where she gets rehab and then if not back to full independent living, there may be a short stay in assisted living while still accessing rehab; then back to full independent living.

[+ WilliamM]

IDK how anyone can leave their parents (or grandparents) in one of those "senior facilities". Saddest place for anyone to end up in besides prison ?

 

For the first few years of my mother's experience in a nursing home, we were able to afford a private room She wasn't suffering from complete dementia then, and could invite her women friends in for a long conversation. Made a sad situation much less sad.

[+ stevenkesslar]

Germany extends social distancing rules until June 29

Regions can allow up to 10 people, or members of two households, to meet in public.

 

Germany has substantially reopened, with many shops, factories, and at least some schools back. They're now recognized as one the global leaders on "best practices". It seems like one of many things they got right is to limit any kind of large gatherings while they also attempt to get most functions of the economy up and running. Large sports events and festivals are banned through at least the end of August.

 

Here's an interesting and encouraging trip down memory lane:

 

Coronavirus: Up to 70% of Germany could become infected - Merkel

March 11, 2020

 

It's not clear whether the tone of that message was meant to indicate inevitability, a desired outcome - or, more likely, a worst case scenario. But nothing like that has come to pass. On it's worst day, March 27, Germany peaked at just under 7000 cases a day. In the last week they've had between 273 and 692 cases a day. The Bundestag just passed a new law that envisions ramping up mass testing further and hopefully "wiping out the virus for good". That sounds ambitious, maybe impossible. But it's a long way away from the inevitability of herd immunity.

 

Germany's peak caseload is actually comparable to the US, since their population is about one-fourth the sizes of ours. So with that adjustment, their peak of 7000 cases is in the ballpark of our peak days, which were in the ballpark of 30,000 per day.

 

Here's a good summary of why Germany has done a good job reducing infections:

 

Germany is reopening with one of the lowest death rates in the world. Here's how it barely missed a trick as it fought the coronavirus.

As Business Insider reported in late March, this was attributed to an early lockdown, swift mass-testing drive, a well-oiled healthcare system, and clear government messaging. Seven weeks on — as the country starts to reopen — not much has changed.

 

In addition to focusing on testing from the start of the outbreak, Germany also got contact tracers up and running very quickly. Here's a detailed article on that effort, that mostly compares Germany's successes to the UK's failures.

 

Germany Has Shared The Details Of Its Coronavirus Contact Tracing Operation. The UK Won’t.

 

This line from the article struck me, simply in terms of the scope and the speed of the effort:

Contact tracing has remained central to Germany's strategy to tackle COVID-19. Even as the country prepared to go into lockdown, it moved quickly to scale up capacity. A spokesperson for the state of Baden-Württemberg shared data showing that the region had 549 contact tracers on March 1. By May 7, that figure had risen to 3,036.

 

March 1 is basically a few days after the first German death from COVID-19. I wonder whether the states already has teams of contact tracers in place for other infectious diseases that they were able to build on. Either way, they were able to ramp tracing up very quickly.

 

Here's one other paragraph about contact tracing that really struck me. While the article is about Germany, it mentions other countries, like Iceland, that have done a particularly good job:

Since the beginning of the outbreak, Iceland has had a policy of quarantining individuals who have been in contact with infected individuals. More than 5% of the population has completed a quarantine period of up to 14 days. And in a clear indication of how aggressively it has traced contacts, 57% of those who have tested positive for COVID-19 were already self-isolating when they were diagnosed.

 

It struck me that if over half of Iceland's infected citizens are already isolated by the time they test positive, because they were contact traced and isolated and tested, that would explain why countries like Germany and Iceland have been able to slow the spread of infection rapidly and decisively. The US or UK are unable to do the same, probably in part because there is less testing, and a lot less contact tracing and isolation. These numbers suggest that there could still be armies of people in the US who are asymptomatic and spreading the virus.

 

This also made me think that Germany's peak of 7500 cases may not be in the ballpark of the US's 30,000 cases, after all. Even though our population is about four times larger. In the US, given the lack of testing and tracing, it's a certainty that those diagnosed cases are a small fraction of the actual infections. The places that have done antibody tests, like New York, confirmed that there might be 10 or more infections for every diagnosed case. In Germany, it's quite possible that their 7500 cases represented a much higher percentage of the true cases out there. They made an aggressive effort to find infected people, test them, and isolate them. We mostly haven't done that yet.

 

Another thing that became clear to me reading this is that the lack of large gatherings in Germany helps them with their contact tracing. If there's lots of crowds, it's obviously impossible to know some or even most people you were in contact with. If gatherings are limited to a few people, if you do get infected it makes it much easier to identify who you might have infected. And to get to them quickly before they infect others.

 

Unrelated to Germany but related to contact tracing, Santa Clara County's Chief Health Officer Sara Cody had this to say today about Gov. Newsom's announcement that religious gathering and other large gatherings of up to 100 people can occur:

Cody was most disturbed by Newsom’s actions to expand the number of people to gather in public, a move she warned would overwhelm “our current ambitious and unprecedented effort” to establish a large network to track and trace the spread of the virus as the state reopens.

 

That concern makes sense. Most of the large European countries - Italy, France, Spain, Germany - have all reduced their new infections by 80 or 90 %. Australia, South Korea, and Japan are all examples of medium-sized countries that have few daily infections. But many US states, including California, seem stuck at a plateau that won't go down. In California we've been at a plateau of about 2000 new cases a day for about a month.

 

I've assumed it was because there's a small minority of people who just won't abide by masks or social distancing, and end up getting infected. But when I read Cody's statement it made me realize that we could also be stuck at a plateau because there's a subset of asymptomatic spreaders that just keep infecting more people, Some of whom then become the next cycle of asymptomatic spreaders. If that's true, we're going to remain stuck until we get both testing and contact tracing going to find and isolate those infected people. It seems like that is what Germany and many other countries have gotten to be very good at. And that is in part why their number of new cases is down 95 % or so from the peak.

 

One final short video that is worth watching:

Sentiment downbeat as German stores reopen

 

I've posted this Open Table reservation data from late February and early March several times. I think what it indicates is that long before any government lockdown, there was a sharp market lockdown that was driven by consumer fear.

 

Germany is now experiencing the flip side of that. It also appears to be happening in the US in states like Georgia and Texas. Businesses may be open. But that doesn't mean people will come. In Germany it's not clear how much of this is the economic pain of the pandemic, meaning people have less money, and how much of it is fear of going shopping or eating out. Those two things obviously reinforce each other. The more fear there is and the longer it lasts, the more the economy will be stuck. That is probably why the Bundestag is talking about trying to get rid of the outbreak for good. So that consumer confidence can actually start to get back to normal.

 

Mostly this is good news. Germany has come a long way from March 11th, when they were talking about 70 % of Germans being infected.

Edited May 28, 2020 by stevenkesslar

[+ bigjoey]

For the first few years of my mother's experience in a nursing home, we were able to afford a private room She wasn't suffering from complete dementia then, and could invite her women friends in for a long conversation. Made a sad situation much less sad.

I have talked about building design taking fighting infection into account. One aspect of the skilled nursing facility where I volunteer is that almost all the rooms are private rooms. This was done for better outcomes for the residents:

1-less infection became everyone is separated with their own bathroom. Two (or more) people sharing a bathroom is a guarantee that if one has an infection the other(s) will get it as well.

2-less stress with no arguments over noise, TV, visitors, room temperature, personal possessions, etc. less stress means quicker recovery in rehab and less medical issues for long term residences. Private rooms give residents more control over their surroundings and residents are encouraged to decorate their rooms as they want (especially important with long term residents).

 

We have a few double rooms which were constructed at the ends of the building so there was still some privacy and were not rectangle rooms but more like overlapping squares. These were designed for occupancy by two spouses, siblings, parent-child or two friends who chose to live together.

 

Best part: no difference between those on Medicaid, Medicare and full private pay. Staff does not know who is there under which payment and there is no difference in services to any resident due to payment method. This was done so that dignity of the residents is preserved. No one needs to feel shamed at being poor and treated differently. When someone’s money runs out, they are not wheeled out of their private room into a shared room.

 

Bottom line, the building design in this one aspect alone of having almost all private rooms made for better medical outcomes including infection control. Other design elements to cut infections included two special isolated rooms for residents who had an infection; the rooms had their own HVAC with negative air pressure to keep germs in the room and not out in the hallway.

[xyz48B]

People are really invested in this…

[+ WilliamM]

I have talked about building design taking fighting infection into account. One aspect of the skilled nursing facility where I volunteer is that almost all the rooms are private rooms. This was done for better outcomes for the residents:

1-less infection became everyone is separated with their own bathroom. Two (or more) people sharing a bathroom is a guarantee that if one has an infection the other(s) will get it as well.

2-less stress with no arguments over noise, TV, visitors, room temperature, personal possessions, etc. less stress means quicker recovery in rehab and less medical issues for long term residences. Private rooms give residents more control over their surroundings and residents are encouraged to decorate their rooms as they want (especially important with long term residents).

 

We have a few double rooms which were constructed at the ends of the building so there was still some privacy and were not rectangle rooms but more like overlapping squares. These were designed for occupancy by two spouses, siblings, parent-child or two friends who chose to live together.

 

Best part: no difference between those on Medicaid, Medicare and full private pay. Staff does not know who is there under which payment and there is no difference in services to any resident due to payment method. This was done so that dignity of the residents is preserved. No one needs to feel shamed at being poor and treated differently. When someone’s money runs out, they are not wheeled out of their private room into a shared room.

 

Bottom line, the building design in this one aspect alone of having almost all private rooms made for better medical outcomes including infection control. Other design elements to cut infections included two special isolated rooms for residents who had an infection; the rooms had their own HVAC with negative air pressure to keep germs in the room and not out in the hallway.

 

Smart people seek advice from neighborhood senior centers, doctors, relatives and friends before nursing homes.

[+ bigjoey]

Smart people seek advice from neighborhood senior centers, doctors, relatives and friends before nursing homes.

Yes, when a person is looking for themself or a family member, they should get all the input possible. Professionals like doctors, social workers and social service agencies as well as hospital discharge planners should be at the top of the list.

 

If someone wants to do the legwork, the inspection reports are available to the public. They can be invaluable. Because staff is so important, I would concentrate on that aspect of research.

 

One thing to notice during any tour is smell. A skilled nursing facility should not have a urine smell.

 

The last thing on which I would rely would be the sales pitch and shiny brochures.

[+ WilliamM]

I have talked about building design taking fighting infection into account. One aspect of the skilled nursing facility where I volunteer is that almost all the rooms are private rooms. This was done for better outcomes for the residents:

1-less infection became everyone is separated with their own bathroom. Two (or more) people sharing a bathroom is a guarantee that if one has an infection the other(s) will get it as well.

2-less stress with no arguments over noise, TV, visitors, room temperature, personal possessions, etc. less stress means quicker recovery in rehab and less medical issues for long term residences. Private rooms give residents more control over their surroundings and residents are encouraged to decorate their rooms as they want (especially important with long term residents).

 

We have a few double rooms which were constructed at the ends of the building so there was still some privacy and were not rectangle rooms but more like overlapping squares. These were designed for occupancy by two spouses, siblings, parent-child or two friends who chose to live together.

 

Best part: no difference between those on Medicaid, Medicare and full private pay. Staff does not know who is there under which payment and there is no difference in services to any resident due to payment method. This was done so that dignity of the residents is preserved. No one needs to feel shamed at being poor and treated differently. When someone’s money runs out, they are not wheeled out of their private room into a shared room.

 

Bottom line, the building design in this one aspect alone of having almost all private rooms made for better medical outcomes including infection control. Other design elements to cut infections included two special isolated rooms for residents who had an infection; the rooms had their own HVAC with negative air pressure to keep germs in the room and not out in the hallway.

 

Are meals taken in a group dining hall, or in private rooms? Socialization is vital too. My first cousin died ten days ago at age 95, partly from being isolated in her room at assisted living because of the threat of novel coronavirus. For years, she took part in as many group activities as possible. Her children and their families were not allowed to visit.

 

Last August I spent one day at good hospital in Washington District of Columbia. I wasn't that sick, but it took several days to recover mentally.

[+ bigjoey]

Are meals taken in a group dining hall, or in private rooms? Socialization is vital too. My first cousin died ten days ago at age 95, partly from being isolated in her room at assisted living because of the threat of novel coronavirus. For years, she took part in as many group activities as possible. Her children and their families were not allowed to visit.

 

Last August I spent one day at good hospital in Washington District of Columbia. I wasn't that sick, but it took several days to recover mentally.

In the assisted living part of the facility, there are three meals a day, seven days a week. There are 54 apartments with mostly singles but a few couples. There are three two bedroom units that have full size kitchens and the other units have a small kitchen area with a refrigerator, microwave and sink.

 

Meal service is available in communal dining areas as well as room service on request. Choices include several options including Kosher plus (like McDonald’s), breakfast for any meal (a lot of seniors like eggs or oatmeal for dinner).

 

The 54 units are in six “pods” of nine rooms. Each “pod” has a common sitting area with access to outdoor space. The people often come out of their apartment to sit in the common spaces in the pods as well as the larger spaces throughout the building including a library, chapel (all types of religious services), art gallery with changing exhibits, lobby area, outdoor areas, art and craft room, elder spa with indoor pool and exercise machines and classes, etc. Normally, there is a full set of activities (cut back because of Covid19 and people not coming into the building). Much of the social activities have been moved to the small common spaces in the pods so the groups are small. The activity director is limiting social activities to the small common spaces with several things each day to pull residents out of their rooms to socialize.

 

Part of the building design was to cut down on infection transmitted by having these small groups. The skilled nursing area is similar in that the rooms in a small area are clustered around a common space in addition to a larger space for everyone on a floor.

 

Right now, the larger common dining areas are closed. Meals are brought to the individual apartments or to the smaller common sitting areas for the nine apartments. The thinking is that IF someone becomes infected, they might be able to limit the infection to just one small area. This design was done for infections like the annual flu in mind but is serving the facility well during this pandemic.

 

The state has a mandated lockdown on all senior facilities including but not limited to nursing homes. For people who are dying, it is hard on families as well as the resident not to have visitors; that is the current mandate in most states as I understand it. Very hard on all concerned.

[+ WilliamM]

In the assisted living part of the facility, there are three meals a day, seven days a week. There are 54 apartments with mostly singles but a few couples. There are three two bedroom units that have full size kitchens and the other units have a small kitchen area with a refrigerator, microwave and sink.

 

Meal service is available in communal dining areas as well as room service on request. Choices include several options including Kosher plus (like McDonald’s), breakfast for any meal (a lot of seniors like eggs or oatmeal for dinner).

 

The 54 units are in six “pods” of nine rooms. Each “pod” has a common sitting area with access to outdoor space. The people often come out of their apartment to sit in the common spaces in the pods as well as the larger spaces throughout the building including a library, chapel (all types of religious services), art gallery with changing exhibits, lobby area, outdoor areas, art and craft room, elder spa with indoor pool and exercise machines and classes, etc. Normally, there is a full set of activities (cut back because of Covid19 and people not coming into the building). Much of the social activities have been moved to the small common spaces in the pods so the groups are small. The activity director is limiting social activities to the small common spaces with several things each day to pull residents out of their rooms to socialize.

 

Part of the building design was to cut down on infection transmitted by having these small groups. The skilled nursing area is similar in that the rooms in a small area are clustered around a common space in addition to a larger space for everyone on a floor.

 

Right now, the larger common dining areas are closed. Meals are brought to the individual apartments or to the smaller common sitting areas for the nine apartments. The thinking is that IF someone becomes infected, they might be able to limit the infection to just one small area. This design was done for infections like the annual flu in mind but is serving the facility well during this pandemic.

 

The state has a mandated lockdown on all senior facilities including but not limited to nursing homes. For people who are dying, it is hard on families as well as the resident not to have visitors; that is the current mandate in most states as I understand it. Very hard on all concerned.

 

I don't really need all this information. I visited my six grade teacher in Massachusetts in a very nice assisted living facility. She remembered me immediately, but very difficult to have a real conversation because her world had because quite small. She did remember 60 years ago when I started the conversation. Otherwise, she responded more like an elementary school principal - her job for many years after my school year, 1954-55

 

That's the issue I have with this amazing place in Kansas.

 

Too upbeat and sunny.

[+ bigjoey]

I don't really need all this information. I visited my six grade teacher in Massachusetts in a very nice assisted living facility. She remembered me immediately, but very difficult to have a real conversation because her world had because quite small. She did remember 60 years ago when I started the conversation. Otherwise, she responded more like an elementary school principal - her job for many years after my school year, 1954-55

 

That's the issue I have with this amazing place in Kansas.

 

Too upbeat and sunny.

 

That makes no sense. The goal is to maintain seniors functioning at the highest mental and physical level possible. That involves hard working staff and volunteers. The aim is to treat people with dignity and respect so they feel valued and that life is worthwhile.

 

Sorry that does not meet with your approval.

 

(The information was given to help you understand the answer to your question. People are given choices about such things as meals as well as how the Covid19 pandemic has affect the normal routine.)

[+ WilliamM]

That makes no sense. The goal is to maintain seniors functioning at the highest mental and physical level possible. That involves hard working staff and volunteers. The aim is to treat people with dignity and respect so they feel valued and that life is worthwhile.

 

Sorry that does not meet with your approval.

 

(The information was given to help you understand the answer to your question. People are given choices about such things as meals as well as how the Covid19 pandemic has affect the normal routine.)

 

You are describing something the way a relatively newcomer would see a nursing home or assisted living facility.

 

How about after living there a few years, and dealing with added health problems, or beloved children trying to visit often but alas dealing with rebellious tennagers and long hours at work.

 

One needs to visit these wonderful places frequently and sometimes at unexpected hours - not just at lunch or dinner or breakfast. Is there enough heat on cold mornings in the Winter? Get to know the staff and the supervisors. Know the relatives of the other people who live there: check in occasionally at the local senior center. Visit frequently at hospitals when seniors are there. Be concerned about feeding tubes and ventilators.