From the Record:
“Blame game? Cuomo takes heat
over nursing home study”
Gov. Andrew Cuomo is facing
blistering criticism over an internal report that found a controversial state
directive that sent thousands of recovering coronavirus patients into nursing
homes was “not a significant factor” in some of the nation’s deadliest nursing
home outbreaks. Scientists, health care professionals and elected officials
assailed the report released last week for flawed methodology and selective
stats that sidestepped the actual impact of the March 25 order, which by the
state’s own count ushered more than 6,300 recovering virus patients into
nursing homes at the height of the pandemic. And some accused the state of
using the veneer of a scientific study to absolve the Democratic governor by
reaching the same conclusion he had been floating for weeks — that unknowingly
infected nursing home employees were the major drivers of the outbreaks. “I
think they got a lot of political pushback and so their response was, ‘This
isn’t a problem. Don’t worry about it,’” said Rupak Shivakoti, an
epidemiologist at Columbia University’s Mailman School of Public Health. “It
seems like the Department of Health is trying to justify what was an untenable
policy,” added Charlene Harrington, a professor emerita of nursing and
sociology at the University of California at San Francisco. Cuomo, who has been
praised for leadership that helped flatten the curve of infections in New York,
has also been criticized over his handling of nursing homes, specifically the
order that told homes they could not refuse to accept recovering COVID-19
patients from hospitals as long as the patients were “medically stable.” The
order barred homes from even testing such patients to see if they still had the
virus.
The directive was intended to
free up hospital beds for the sickest patients as cases surged. But relatives,
patient advocates and nursing home administrators have called it a misguided
decision, blaming it for helping to spread the virus among the state’s most
vulnerable residents. Cuomo reversed the order under pressure May 10, long
after New York’s death toll in care homes had climbed to among the highest in
the nation. To date, nearly 6,500 deaths have been linked to the coronavirus in
the state’s nursing home and long-term care-facilities. But the 33-page state
report flatly says "that nursing home admissions from hospitals were not a
driver of nursing home infections or fatalities.” Instead, it says the virus’
rampant run through New York nursing homes was propelled by the 37,500 nursing
home workers who became infected between mid-March and early June and
unknowingly passed the virus on. The report noted that the number of residents
dying at nursing homes peaked on April 8, around the same time as COVID-19
deaths statewide, but nearly a week before the peak of coronavirus patients
being transferred from hospitals. It also said 80% of the 310 nursing homes
that admitted coronavirus patients already had a confirmed or suspected case
among its residents or staff before the directive was issued. And it contends
the median number of coronavirus patients sent to nursing homes had been
hospitalized for nine days, the same period that the study said it likely takes
for the virus to no longer be contagious. “If you were to place blame, I would
blame coronavirus,” Dr. Howard Zucker, the state health commissioner, told
reporters last week. Cuomo said in a later news conference that“ugly politics”
were behind “this political conspiracy that the deaths in nursing homes were
preventable. And now the report has the facts, and the facts tell the opposite
story.”
But several experts who reviewed
the report at the request of The Associated Press said it has fatal flaws,
including never actually addressing the effect of the order. Among the
questions not answered: If 80% of the 310 nursing homes that took coronavirus
patients already had cases before the order, what was the effect of the
released patients on the other homes that were virus free? If the median number
of patients were released into nursing homes for nine days, that means that by
the study’s own count more than 3,000 patients were released within nine days.
Could they have been infectious? Denis Nash, an epidemiologist at the City
University of New York School of Public Health, also noted that New York’s
nursing home death toll doesn't include nursing home residents who died at a
hospital, a “potentially huge problem” that undercounts the virus' toll and
could “introduce bias into the analysis.” Among the holes in the study
highlighted by University of Texas, Houston, epidemiologist Catherine Troisi
was a lack of data on what happened at dozens of nursing homes that had no
COVID-19 infections before those sick with the virus were sent to them. “Would
this get published in an academic journal? No,” Troisi said. Shivakoti said he
thinks the report may be correct in concluding that the major drivers of the
outbreaks were nursing home workers who were sick without knowing it. But
that's not the same as saying the discharges played no role. “If they didn’t
infect other patients directly,” Shivakoti said, “they still could have
infected a worker.” Dr. Mark Dworkin, a former Illinois state epidemiologist,
said the finding that people don’t transmit the virus after nine days of
illness applies in the population at large, but it’s not clear whether that’s
true of nursing home residents who may have weaker immune systems and shed the
virus longer. He said the state's report used “overreaching” language. "They
really need to own the fact that they made a mistake, that it was never right
to send COVID patients into nursing homes and that people died because of it,”
said Dr. Michael Wasserman, president of the California Association of Long
Term Care Medicine. New York Department of Health spokesman Gary Holmes said
the study was intended to “measure the strength of the variables. ... The
strongest factor in driving the nursing home infections was through staff
infections.”
The Cuomo administration report will
likely not be the last word. New York’s Legislature plans to hold joint
hearings next month, and Republicans in Congress have demanded Cuomo turned
over records on the March 25 order and its effects. “Blame-shifting,
name-calling and half-baked data manipulations will not make the facts or the
questions they raise go away,” Louisiana U.S Rep. Steve Scalise, Republican
leader of a House subcommittee on the COVID crisis, wrote in a letter to Cuomo
last week. Asked to respond, Cuomo spokesman Rich Azzopardi said: “We’re used
to Republicans denying science but now they are screeching about time, space
and dates on a calendar to distract from the federal government’s many, many,
embarrassing failures. No one is buying it.”
^ All the fatal flaws, decisions,
actions and inactions related to those that died from Covid-19 (especially in
Nursing Homes) needs to be independently investigated, the findings made public
and real change implemented to prevent any new deaths. I don’t live in New York
anymore, but two of my “local” TV channels are based in New York and Vermont
and so everyday I saw Cuomo’s Covid-19 press conference. Besides not having ASL
interpreters (until being forced to by an ADA-case being filed against him) it
seemed Cuomo was more concerned with Cuomo rather than keeping the public
informed and safe. If that is how he appears in front of the camera it shouldn’t
surprise any one about what he does behind the scenes. He isn't the only politician to do this, but is one whose actions/inactions needs to be investigated. ^
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