Researchers from the University of Notre Dame in America have analysed the deaths data from U.S. nursing homes and come to a disturbing, if not unexpected conclusion. While ‘higher quality’ nursing homes generally had lower Covid deaths, they had higher overall deaths, and this appears to be because the brutal Covid isolation protocols they followed to reduce transmission proved deadly in their own right. Furthermore, while the difference between the Covid death rates in higher and lower quality nursing homes diminished after the first wave, the difference in total overall deaths continued to increase, suggesting, tragically, that the brutal protocols were continued long after they ceased offering any benefit at all.
The background to this tragedy is that on March 13th 2020, the U.S. Centers for Medicare and Medicaid (CMS) recommended that nursing homes restrict “visitors and non-essential personnel” from entering the home and cancel “in-person dining and other group activities”. These policies, the researchers write, came at a considerable cost in human wellbeing: “An abundance of qualitative evidence from nursing home staff, administrators, and resident family members suggests that the lack of in-person contact with loved ones and other residents not only generated feelings of loneliness, isolation, and despair, but may have also expedited death.”
Existing research shows that social isolation increases both dementia severity and the likelihood of adverse outcomes among those with Alzheimer’s and mortality among the elderly. According to CDC provisional data, there were 56,464 excess deaths (i.e., realised deaths above that which is predicted using historical averages) among Alzheimer’s patients through early October of 2021; however, only 22,709 or 40% had a corresponding positive COVID-19 diagnosis, leaving 60% of these excess deaths not directly related to the disease but to other aspects of the pandemic.
The researchers found that, as of September 13th 2020, five-star homes had experienced 11.4% more non-Covid deaths than one-star homes, all else equal; by April 15th 2021, this figure had grown to nearly 15%. (Note these figures are based on modelling that controls or adjusts for confounding factors, not just raw data.) The additional deaths likely result from isolation and loneliness, the authors argue, citing research from Connecticut nursing homes which documented “substantial weight loss and increases in severe pressure ulcers among residents who did not contract COVID-19″. The same study also found that only 5% of respondents had visitors three or more times per week, compared to 56% before the pandemic, and just 13% reported dining in a communal setting, compared to 69% before the pandemic. An additional factor, the authors note, may be a reduction in interactions with healthcare providers, both inside and outside the home.
The authors observe with dismay that even by the end of June 2021, visits to nursing homes were still down by 35% compared to January 2020 levels, likely contributing to the continued additional mortality.
They conclude that more balanced policies are required that aren’t so obsessed with one risk factor that they lose sight of harms done in the process.
Our results suggest that more balanced policies and guidelines that emphasise maximizing the health of residents, rather than just minimising risk to one disease, may have improved outcomes. For a period of time, CMS and the news media at large measured nursing home COVID-19 performance using cases and deaths only, meaning the logical response on the part of the nursing home was to minimise these counts regardless of the cost. In retrospect, the tone of the discussion and the measurement of outcomes may have led to some deadly consequences. As economists continually stresses, there are benefits and costs to all regulations.
The inhumanity that has characterised the monomania with which authorities and much of the public have chased after minimising Covid infections and deaths at the expense of everything that makes life worth living – and doing so for an indefinite period of time – is perhaps the worst aspect of the pandemic. None, perhaps, have suffered under this blinkered approach more than the very vulnerable people in care homes, for many of whom it actually cost them their lives. I’d like to think we can learn from this and pledge it will never happen again, but the way many leaders are currently behaving over vaccine passports leaves me with little hope that such lessons can be learned, and the inhumanity will continue and keep appearing in new guises.