Deaths from COVID -19 Continue to Rise

Today the New York Time has an extraordinary front page, there were no photos, no articles of interest, no headlines.  There are just names – 1000 names, to be precise – about one percent of the total deaths from COVID-19 seen so far this year. These names cover the front page and tumble inside for a few more pages. This is an effort to show that these deaths are not numbers or statistics alone, they represent lifetimes lived sometimes courageously, sometime outrageously, but lived each in its own unique way.  Americans are proud of their individualism and it shows in these descriptions which were culled from obituary pages in papers across the nation and briefly noted here: last names omitted by me: “(Susan, 74 – Palm Beach Florida – loyal and generous friend to many; Morris, 90 – Northbrook Illinois – Endlessly curious, never really finished; April, 33 – Baton Rouge, Louisiana, advocate for disability rights; Cornelius, 84, -  Bellevue Washington, sharecroppers son)”. These are strangers, friends or neighbors, people just around the corner, perhaps, others whom we never knew but who helped make our country what it is today.

Tidbits from here and there:

This weekend The White House noted both Memorial Day and the COVID-19 deaths approaching the 100,000-total mark by flying flags at half staff and ordering that this be done nationwide.  It seems a bit of a tardy response, but hey, better than nothing, as they say. But by Tuesday it will be back to opening up for business everywhere.  The odd declaration by the President that all states must open churches, synagogues and mosques this weekend seemed more political than politic, as religious gatherings at close quarters have presented some of the most often noted sources of infections.  Of course, as was swiftly noted by many commentators, he does not have that right, constitutionally, anyway!

Beaches were crowded along the East Coast as formerly locked down sunseekers headed for the surf and sand nearby.  There were reports of crowds, few masks or social distancing in many places.  This is far too early to break free; it seems to me.

Doctors Without Borders have arrived in the southwest to assist in the virus outbreak in the Navajo Nation and other tribal areas. They are usually known for arriving in third world hot spots with famine and disease outbreaks.  What does this say about American healthcare?

GO Fund Me efforts by these Native Americans have been aided by an outpouring of donations from the country of Ireland which was giving payback for the aid these tribes sent to Ireland during the 1840’s potato famine. So far, the Irish have donated more than $600,00 to support the struggling nations.

COVID-19 Totals from the Centers for Disease Control: 5-24-20 

Total number of cases – US = 1.622,114.   Total number of Deaths = 97,049 about 7,000 more than last week.

Total number of cases in MD = 46,313.      Total number of Deaths = 2,162 approximately 700 more than a week ago.

Return to a problem:

Last week I mentioned that approximately 30% of the deaths in the United States came from patients in nursing homes. That means 30,000 people who could have been protected from infections with a better care system! The first major US COVID-19 outbreak happened in a nursing home in the State of Washington and eventually accounted for 37 deaths in that facility.  Later tests revealed that there were multiple deficiencies in this center, which is part of a nationwide chain of nursing homes.  This home has been fined for inadequately providing for its residents.  Senator Ron Wyden (D-WA) asked the General Accounting Office (GAO) to do a study of incidence of infections in the homes and how Medicare was monitoring this care.  The findings will be summarized below.  

But Senator Wyden was critical of the way HHS is monitoring this care: “This new report shows that warning signs were ignored and nursing homes were unprepared to face a pandemic,” Wyden said. “For years nursing home surveys pointed out areas where federal standards for nursing home safety and enforcement efforts should be improved, but the Trump administration chose not to correct them. Too many seniors and their families have suffered as a result of this pandemic, and there need to be big changes in the way nursing homes care for seniors.”

The report included a pie chart noting that 18% of the homes were not cited for infection control problems.  However, 82% were noted for having infection control prevention deficiencies in one or more years.

The report goes on to note that improper techniques for infection control such as lacking masks and personal protective equipment, while important, were not cited as important an offense as was the inability to isolate a patient with Methicillin Resistant Staph Aureus (MRSA), which is contagious.  It did note that a home was cited in New York State for failure to contain an outbreak of respiratory illness in a previous year which sickened 38 residents. That report went on to say that homes need to isolate persons who are sick with symptoms away from other residents and keep the staff who care for them away from communal areas such as dining rooms.  These are not new concepts, but with lax enforcement and trivial penalties, when cited, many homes do not make the efforts necessary to comply.  For a home of the average size – which is only 108 beds, it may not be easy to set up a separate wing for sick patients as they operate usually at about 80% capacity. Unlike acute care facilities which have gone over to single occupancy rooms, many nursing homes still have rooms which have 2 to 4 occupants. This increases the ease of infection spread and makes it more difficult to relocate patients. Staff turnover is high as the wages are low and new staff is not always well educated on infection control processes.  Medicare (CMS) sets standards and states are required to enforce them; however, homes are usually visited only once a year unless deficiencies are found, which need corrections right away. GAO plans to review these CMS standards more deeply in a future report.

Many do not realize that Medicare only covers and pays for nursing home care in limited circumstances, such as rehabilitation after a hip replacement, for example.  Medicaid, which is jointly funded by the Federal government matching funds with each state individually, accounts as the payer for 62% of nursing home costs; 69% of the nursing homes are for profit businesses.

According to the Kaiser Family Foundation, there were approximately 1.6 million people in nursing home care in the US recently living in some 16,000 facilities. Annual costs without extras – and everything is an extra – averages about $80,000; far beyond the ability of most seniors or their families to afford. Many of the patients in long term care facilities need personal care as 60% have issues with mobility, meaning that they need help getting up and around and may need help using the bathroom, with bathing and getting in a wheelchair or using a walker. This population needs to be protected from falling, as they are often on many medications and have balance and visual perception deficits. These matters require hands on care.  Those who have issues with dementia, or need Alzheimer’s care, have cognition problems and may not comprehend what they need to do or even where they are, which makes their care more difficult.  There are many other concerns such as incontinence, bedsores, over medication and fragility which factor into the need for knowledgeable caring personnel to be able to meet the needs of these often helpless, elderly and keep them safe.  

I do not have a solution for these issues. It seems that there must be a way to take care of these senior citizens who need such direct care and often cannot look after themselves. The physical demands of caring for such ill or debilitated patients is often beyond the capacity of many families, which creates the need. As a society, we have made many medical advances as some people are indeed living to extreme ages; medicine has not, however, helped us learn how to protect these patients and meet their needs in a manner which respects their dignity and treats them as fellow humans.

Until next week, the news keeps driving the agenda.  Who do you think VP Biden should choose as a running mate? Let me hear from you!  Do you have a solution for long term care? What is your opinion on opening up vs. staying home?  What do you think about AG Barr?

Stay safe!