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COVID-19: More than 40% of all deaths associated with long-term care facilities

Reports: For those under 50, death rate is 1 in 10,000; under 25, 1.5 per million

July 03, 2020 by Richard Moore

It is one of the most underreported statistics of the COVID-19 pandemic and lockdowns: at least 43-45% of all deaths related to the novel coronavirus — both nationally and in Wisconsin — are associated with nursing homes, assisted living facilities, and other group home settings, either among residents or workers at the facilities.

In 24 states, the New York Times reports, the number of residents and workers in such settings who have died accounts for half or more of all deaths from the virus. Overall nationally, the newspaper estimated that 43% of the nation’s coronavirus deaths were linked to nursing homes.

As statistics about COVID-19 accumulate, the message gets clearer and clearer — the most at-risk population is the very elderly, and particularly the very elderly in long-term care facilities, while younger people are much less affected, as low as one death in 10,000 for those under 50 in one estimate, with those under 25 having about a 1.5 per million risk of dying, according to another.

The New York Times’ numbers came from its own database, which the newspaper says is based on confirmed reports from federal, state and local government sources, as well as facilities themselves.

But other entities and analyses have corroborated the statistic.

For example, using state-by-state COVID-19 fatality reports, an analysis by the nonpartisan Foundation for Research on Equal Opportunity (FREO) found that 45 percent of U.S. COVID-19 deaths have occurred in nursing homes and assisted living facilities. As of June 27, those death rates are highest in New Hampshire, North Dakota, Rhode Island, and Minnesota, according to the report.

The high fatality rate in group home settings is observable everywhere. In Wisconsin, for example, as of June 29, Wisconsin had attributed 777 deaths to COVID-19. Forty-four percent had occurred in nursing home and long-term care facilities, while 5% more had taken place in other group home settings, for 49% of total deaths.

In contrast, the group home population represented just 7% of the total COVID-19 cases in the state.

In its analysis, the FREO used three different calculations to determine the fatality rate in nursing homes and assisted living facilities. First, the group reported, among states reporting nursing home fatalities, COVID-19 reportedly killed 2.5% of residents of nursing homes and residential care facilities. 

“We estimate that 2.1 million Americans over 65 live in nursing homes and residential care facilities; by extrapolating 2.5% across the entire U.S. nursing and residential care home population, we estimate that nursing homes account for 45.6% of COVID-19 fatalities,” the report stated.

A simpler estimate assumed that, because states releasing nursing and residential care home deaths from COVID-19 show that 44.9% of total COVID-19 deaths were among that population, the estimate simply assumed that figure across-the board for a 44.9% total.

A third estimate of 53.3% excluded New York state because of controversies surrounding its criteria for classifying COVID-19 deaths, in particular allegations that nursing home deaths were undercounted because the state counts as a hospital death any fatality occurring in a hospital, even though the individual might have actually lived in a long-term care facility.

The FROE report asserts that the U.S. is not an outlier in terms of its nursing home-related COVID-19 fatalities. 

“A study by researchers at the International Long Term Care Policy Network of fatalities in Austria, Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Hungary, Ireland, Israel, Norway, Portugal, Singapore, South Korea, Spain, Sweden, and the United Kingdom found that 40.8% of reported COVID-19 fatalities took place in nursing homes,” the researchers, Gregg Girvan and Avik Roy, stated.

Girvan and Roy said the policy implications of these figures are significant and suggested substantial flaws in the way the nation has managed the COVID-19 pandemic. 

“Much more attention must be paid to the risk of SARS-CoV-2 infection in nursing homes, especially through nursing home staff who work at multiple facilities,” they wrote. “Nursing homes must use best practices for testing and cleanliness.”

On the flip side, Girvan and Roy wrote, people under 35 represent just 0.8% of deaths.

“States and localities should consider reorienting their policy responses away from younger and healthier people, and toward the elderly, and especially elderly individuals living in nursing homes and other long-term care facilities,” they wrote.

Assuming 150,000 total deaths from COVID-19 in the U.S., the odds of an individual under 25 dying from COVID-19 are around 1.5 per million, or 1 in 669,000, the researchers estimated.

Decreasing deaths rates

Beyond living in long-term care facilities, the fatality statistics continue to show that the most vulnerable people are those who have passed the age of 70, especially those with underlying conditions, and that the fatality risk is much lower for the general population — worse than the average flu season but comparable to a season with a severe flu strain, such as the 1968 Hong Kong flu.

According to the CDC, nearly 60% of COVID-19 deaths in the U.S. have been among people 75 or older. The greatest risk for severe illness from COVID-19 is among those aged 85 or older.

Writing in the New York Post this week, former New York Times reporter Alex Berenson, the author of “Unreported Truths about COVID-19 and Lockdowns,” put the risk of dying from COVID-19 in perspective.

“In fact, the Centers for Disease Control and Prevention ­esti­mated in May that the coronavirus kills about 0.26% of the people it infects, about 1 in 400 people,” Berenson wrote. “New estimates from Sweden suggest that only 1 in 10,000 people under 50 will die from the virus, compared to 1 in 14 of people over 80 and 1 in 6 of those over 90.”

What’s more, this week, according to the CDC, overall deaths attributed to pneumonia, influenza, or COVID-19 (PIC), were decreasing.

“Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.5% during week 24 to 6.9% during week 25 but remained above baseline,” the CDC reports for the week ending June 20. “This is the ninth week of a declining percentage of deaths due to PIC, but this may change as more death certificates are processed, particularly for recent weeks.”

Paper tiger?

Studies also show that far more people have been infected with and recovered from the coronavirus than suggested by data from tests that only measure current infections, Berenson reported. Tests of municipal sewage systems — measuring the virus’ genetic signature in wastewater — have had similar findings, he wrote.

Berenson said nearly all antibody studies, which indicate who may have had the virus but are not currently infected, find between 10 and 100 times the number of total infections as reported infections, with the average somewhere around 20 to 25 times.

“In other words, while the CDC reports 2.34 million Americans have been infected with the coronavirus, the actual number of infected and recovered people may be closer to 50 million,” he wrote. “(CDC Director Robert Redfield told journalists Thursday that the number of cases may be 10 times higher than the earlier 2.34 million.)”

Thus, the death rate, which would be 5.2% based on that 2.34 million figure, is actually more like one-20th as high — or 0.26%, Berenson calculated.

The typical death rate from the flu is about .1%.

For many of those testing positive for COVID-19 antibodies — in fact, nearly half of them — no symptoms ever occur. In a study just published in the Annals of Internal Medicine, “Prevalence of Asymptomatic SARS-CoV-2 Infection,” after a review of the literature and studies, researchers now believe it is likely that approximately 40 to 45% of those infected with the novel coronavirus will remain asymptomatic.

That could be a double edged-sword, depending upon your point of view.

For the researchers, led by Dr. Daniel Oran of the Scripps Research Translational Institute in La Jolla, California, the absence of COVID-19 symptoms in infected persons might not necessarily imply an absence of harm, though the study hastens to add that more research is needed. Other research indicates that long-term impacts are more likely to occur in symptomatic individuals requiring critical care.

Others, such as Berenson, take a brighter view, as he discussed on Twitter about large numbers of aysmptomatic test results.

“Counter-intuitive/hopeful theory, based on emails I’m getting about the (huge number of people) in FL/TX with asymptomatic positive tests — what if, as tens of thousands of people have no to mild symptoms, the realization that Sars-Cov-2 is a paper tiger for most of us explodes?” he wrote on Twitter.

Higher cases, lower hospitalizations

Beyond the COVID-19 fatality numbers and asymptomatic cases are hospitalization numbers and their relationship to overall case numbers.

As lockdowns have ended in many states and as more testing has been done, case numbers have been rising, and most of the headlines focus on those numbers. For the week ending June 20, the CDC reports, the overall cumulative COVID-19 hospitalization rate was 98.4 per 100,000, with the highest rates in people aged 65 years and older (297.6 per 100,000) and 50-64 years (148.6 per 100,000).

But, while hospitalization rates are increasing in some states in absolute numbers, they are falling in others, and in any case are not keeping pace with the number of diagnosed cases.

As Berenson points out, the link between the number of cases, hospitalizations, and deaths is breaking down. For example, he reported, in Florida as of last week, positive tests were up 500% since early June but hospital admissions and deaths were no higher than mid-May.

In Wisconsin, the number of cases has been growing, and the trend line for the test-positivity rate has been climbing overall, too. The positivity rate peaked at 7.1% on June 28 after a two-week surge before dipping to 5.3% the next day. Total cases in the state have climbed past 28,000.

Still, hospitalizations remain near a low since the pandemic began. On June 29, there were only 236 people hospitalized with the disease in the state, according to Wisconsin Hospital Association data. That was the lowest number since April 2 and continues an overall downward trend in hospitalizations that began in late May.

A major reason that the link between positive cases and hospitalizations has collapsed is that positive tests for those in their 30s and younger are surging, both in Wisconsin and nationally. While 12 percent of all COVID-19 patients in Wisconsin have been hospitalized, that figure is just 3% for those under 30, and 6% for those in their 30s. 

By contrast, 42% of those in their 70s have been hospitalized and 46% of those in their 80s have received inpatient care.

Still, there’s a silver lining in all that news.

For one thing, as the CDC reports, for people 65 years and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points during recent influenza seasons. For children, cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points during recent influenza seasons.

Richard Moore is the author of the forthcoming “Storyfinding: From the Journey to the Story” and can be reached at richardmoorebooks.com.

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