Nursing homes are supposed to be places of refuge for those who need long-term medical care and support. They are home to some of our most vulnerable, usually elderly people. Sadly, they have become death traps for many, especially in some states.

Avik Roy, writing in Forbes, says 2.1 million Americans, representing 0.62% of our population, reside in nursing homes and assisted living facilities. In a recent analysis, performed by Roy and Gregg Girvan for the Foundation for Research and Equal Opportunity, they studied the number of nursing home-related deaths due to the COVID-19 virus. They found 42% of all deaths due to the virus, in the 43 states reporting figures, occurred in nursing homes and assisted living facilities.

42% of all COVID-19 deaths happened in facilities that house 0.6% of the population!

These astounding numbers are probably too conservative. In New York, the number of nursing home deaths was certainly under-reported since they chose to exclude any deaths of nursing home residents that occurred after transport to a hospital. Outside of New York, more than half of all deaths from COVID-19 are of residents of long-term care facilities.

Here are some states with the highest percentages:

• Ohio – 70%
• Pennsylvania – 69%
• Minnesota – 81%
• New Hampshire – 70%
• Washington – 61%

Tragically, the decisions of state government officials greatly impacted these figures. In the states of New York, New Jersey, and Michigan, nursing homes were ordered to accept infected patients in transfer from hospitals after discharge. This may have been designed to prevent overcrowding of ICUs, but at the expense of nursing home residents.

New York Governor Andrew Cuomo was outspoken in defending this practice. As recently as April 23, Cuomo declared that nursing homes “don’t have the right to object” to accepting elderly patients with active COVID-19 infections. “That is the rule and that is the regulation and they have to comply with that,” said Cuomo. Only on May 10 – after the deaths of 3,000 New York residents in nursing homes – did Cuomo stand down and partially rescind his order.

Florida Did Better

Florida Governor Ron DeSantis required all nursing home workers to be screened for COVID-19 symptoms before entering the facilities. On March 15, DeSantis signed an executive order banning nursing home visitations by friends or family, and also banned hospitals from discharging patients who were infected with the virus to long-term care facilities.

Florida also prioritized long-term care facilities for personal protective equipment (PPE). DeSantis said, “If I can send PPE to the nursing homes, and they can prevent an outbreak there, that’s going to do more to lower the burden on hospitals than me just sending them another 500,000 N95 masks.”

Roy says we should all learn from the Florida experience. He recommends the following:

• Rescind all state orders to mandate nursing homes accept infected patients
• Restrict visits to nursing homes by friends and family until further notice
• Prioritize PPE for nursing homes at least as high as hospitals
• Test all nursing home workers for active infection
• Limit nursing home workers to one facility when possible
• Force those 7 states not reporting nursing home deaths to begin reporting

The Silver Lining

The silver lining in this story is that the 99.4% of the U.S. population that doesn’t live in nursing homes is roughly half as likely to die of this corona virus than we previously thought. These latest figures show a strong correlation with advancing age, other medical co-morbidities, and nursing home residence. Those who do not fit into these categories are at considerably lower risk.

If you’re one of the 99.4% of Americans who do not live in a nursing home, you should feel better. If you, or your loved ones, do live in a nursing home, you should insist they comply with the above recommendations whenever possible.

Joe Biden likes to promote himself as the moderate candidate. He has resisted pressure from progressives like Senator Bernie Sanders to endorse his Medicare for All plan, which is complete takeover of healthcare by the government and elimination of private health insurance.

But the old saying is, “the devil is in the details.” Biden is inching closer and closer to Sanders’ socialized medicine plan the longer he campaigns. The distinction between the two is getting slimmer and slimmer.

Biden began his campaign stressing he wanted to “protect and preserve ObamaCare.” Back then he wanted nothing to do with Medicare for All. Then he said he wanted to offer a “Public Option”, which would lead to socialized medicine eventually as the government-supported “Public Option” eliminated competition from the private insurance market gradually over time. I explained this in detail in Bernie v. Biden: Medicare for All Sooner or Later. 

Now Biden is taking his move to the left one step farther. Now he’s calling for “Medicare for More.” In this new proposal, Biden wants to reduce eligibility for Medicare from age 65 to age 60. There are multiple problems to this new approach.

Benedic Ippolito and Chris Pope, writing in The Wall Street Journal, say Biden’s plan relies on large cuts to hospital revenues that won’t fly in Congress, especially among Democrats. Moreover, his expansion is poorly designed if the goal is to help the uninsured. Lowering the age of Medicare to 60 would require heavy subsidies from taxpayers. Employers would be prohibited from dropping the newly eligible from their plans.

Currently, hospitals are effectively required to treat Medicare enrollees at rates averaging 59% less than what hospitals receive from employer-sponsored insurance plans. In 2015, adults 60 to 65 accounted for 6% of the U.S. population but 17% of costs paid by private insurers, according to the Department of Health and Human Services. This loss of revenue would seriously impact hospitals and probably lead to many of them closing. Of course, this same impact would be even greater with Medicare for All.

This push to reduce funding of hospitals goes counter to the prevailing Democratic Party leadership which is pushing efforts to expand hospital funding substantially after the Covid-19 pandemic. Republican efforts to end “surprise medical billing” were derailed by the prospect of payment reductions to hospitals.

Another issue is the impact on the uninsured. Currently only 8% of the 60 to 64 age population is uninsured. With this new Biden proposal, Americans would be asked to pick up the tab for those in this age group who are already covered – at a cost of roughly $250 billion a year currently paid by private insurance. Medicare outlays are already expected to double in the next decade and the program’s trust fund is projected to be insolvent in 2026.

This Biden proposal would be subsidizing the income of workers whose median household income was more than $92,000 in 2017. It would help the relatively affluent instead of devoting resources to the most needy. Of the 28.5 million Americans without insurance, only 1.6 million of those are in the 60 to 64 age group according to the Census Bureau.

Joe Biden may think this idea will get him more votes in November, but it won’t fix the flaws in Medicare or assist the families that need help the most. But it will be one step closer to Medicare for All.

Sadly, politicians and a liberal news media are trying to rewrite the science on antibodies. When the whole world is looking for hope for a way out of this corona virus pandemic, these people are questioning the protection that antibodies provide against reinfection with the virus.

Manish Butte, an associate professor and chief of pediatric allergy, immunology and rheumatology at UCLA, and Andrew Bogan, a molecular biologist, write in The Wall Street Journal to help clarify the science behind antibodies. They discuss two type of immune responses to viral infection: innate response and adaptive response.

Innate response occurs within minutes to hours and triggers alarms that result in effects across the body such as fever. Tissues and cells produce “interferons”, molecules that incapacitate many viruses and recruit white blood cells to destroy them. For mild infections, innate responses are sufficient to defeat the virus.

But some viral infections require a second wave of response, adaptive response, which arrives four or five days after infection. Molecular bits of the offending pathogen, known as antigens, are brought to the lymph nodes, where white blood cells called T and B lymphocytes attack the infected tissues, such as the lung for Covid-19. They release cytotoxins to kill infected cells. The over-aggressive immune response causes much of the devastation seen in severe cases of the disease.

As a result of this response, B cells produce antibodies that over several weeks adapt to the pathogen. After the war is over, a few T and B cells linger in the lymph nodes and in the mucosa of the airways, forming an “immunological memory” that is programmed to fight faster and stronger the next time that pathogen appears. This cell memory provides “protective immunity”, which Thucydides first hypothesized in 430 B.C.

For decades, antibody tests have been used as proof of immune response, arising either from infection or vaccination. The presence of antibodies can be detected from a blood sample using a serologic assay. Several tests have published sensitivity and specificity values as high as 99.6% to 100%. These tests are consistent with other antibody tests, such as those for mononucleosis and hepatitis infections, that are in routine use without much concern about their accuracy.

Which brings us to the question, “Why are people doubting the accuracy of antibody tests and claiming they don’t protect people from reinfection with the Covid-19 virus?

Butte and Bogan respond:

“Given the reliability and performance of these tests, it appears to be politics, not science, that is behind the claim that the presence of specific antibodies in those who’ve recovered from Covid-19 doesn’t indicate protective immunity. This is baffling. If it’s true, how does anyone recover from a severe infection?

If these antibodies aren’t protective, then global efforts to develop a vaccine are pointless. Vaccines try to arm T and B cells so they fight quickly when exposed to the virus. If antibodies detected in a person who has recovered don’t confer immunity, then neither would antibodies developed in response to a vaccine. The far more likely scenario, which is true of other corona viruses, is that antibodies do offer protection for a significant duration, so that a successful vaccine could be developed.”

The greatest disappointment of this virus pandemic may be the politicization of the response by those who would prefer a prolonged fear of the virus and shutdown of the economy for months to come – or at least until after the November presidential election.