Canadian physicians - including Canada’s first chief public health officer - have just called for ending lockdowns permanently, even if outbreaks continue.
To:
The Right Honourable Justin Trudeau, P.C., M.P., Prime Minister of Canada
The Honourable Dwight Ball, Premier of Newfoundland and Labrador
The Honourable Caroline Cochrane, Premier of the Northwest Territories
The Honourable Doug Ford, Premier of Ontario
The Honourable Blaine Higgs, Premier of New Brunswick
The Honourable John Horgan, Premier of British Columbia
The Honourable Jason Kenney, Premier of Alberta
The Honourable Dennis King, Premier of Prince Edward Island
The Honourable François Legault, Premier of Québec
The Honourable Stephen McNeil, Premier of Nova Scotia
The Honourable Scott Moe, Premier of Saskatchewan
The Honourable Brian Pallister, Premier of Manitoba
The Honourable Joe Savikataaq, Premier of Nunavut
The Honourable Sandy Silver, Premier of Yukon
Date: July 6, 2020
RE: Dealing with COVID-19: A Balanced Response
The undersigned represent current and past leaders in public health, health care systems and academia. We are writing to you to with our thoughts regarding a balanced approach to dealing with COVID-19 We strongly believe that population health and equity are important considerations that must be applied to future decisions regarding pandemic management.
The current approach to dealing with COVID-19 carries significant risks to overall population health and threatens to increase inequities across the country. Aiming to prevent or contain every case of COVID-19 is simply no longer sustainable at this stage in the pandemic. We need to accept that COVID-19 will be with us for some time and to find ways to deal with it.
The current and proposed measures for reopening will continue to disproportionately impact lower income groups, Black and other racialized groups, recent immigrants to Canada, Indigenous peoples and other populations. And it risks significantly harming our children, particularly the very young, by affecting their development, with life-long consequences in terms of education, skills development, income and overall health.
Canada must work to minimize the impact of COVID-19 by using measures that are practical, effective and compatible with our values and sense of social justice. We need to focus on preventing deaths and serious illness by protecting the vulnerable while enabling society to function and thrive.
Elimination of COVID-19 is not a practical objective for Canada until we have a vaccine. While there is hope for a vaccine to be developed soon, we must be realistic about the time it will actually take to develop and evaluate it and then deliver an immunization campaign covering the entire population. We cannot sustain universal control measures indefinitely.
We need to accept that there will be cases and outbreaks of COVID-19.
We need localized control measures that are risk-based. We should consistently reassess quarantine and isolation periods, recommendations for physical distancing and non-medical masks, and travel restrictions based on current best evidence and levels of risk.
At the same time we must improve infection prevention and control in long-term care and congregate living settings. We should provide support for people living in the community who need to or choose to isolate when the disease is active, as well as those who have been adversely affected by COVID-19, or the consequences of the public health measures.
Canadians have developed a fear of COVID-19. Going forward, they have to be supported in understanding their true level of risk, and learning how to deal with this disease, while getting on with their lives
– back to work, back to school, and back to healthy lives and vibrant, active communities across this country.
We acknowledge the heroic work that has been done in recent months by many across all levels of government and the public and private sector, and the sacrifices that Canadians have made to get to this stage. As we look forward, Canada must balance its response to COVID-19.
Sincerely yours,
Robert Bell, MDCM, MSc, FRCSC, FACS
Former Deputy Minister of Health, Province of Ontario
Former President and CEO, University Health Network, Toronto
David Butler-Jones, MD, MHSc LLD(hc), DSc(hc), FRCPC, FACPM, FCFP, CCFP
Canada’s first Chief Public Health Officer and former Deputy Minister for the Public Health Agency of Canada
Jean Clinton, BMus, MD, FRCPC
Clinical Professor, Psychiatry and Behavioural Neurosciences, McMaster University
Tom Closson, BASc, MBA, FCAE, PEng
Former President and CEO, University Health Network, Toronto
Former President and CEO, Capital Health Region, British Columbia
Janet Davidson, OC, BScN, MHSA, LLD(Hon)
Former Deputy Minister, Alberta Health
Former CEO, Trillium Health Centre
Martha Fulford, MA, MD, FRCPC
Infectious Diseases Specialist
Associate Professor, McMaster University
Vivek Goel, MDCM, MSc, SM, FRCPC, FCAHS
Professor, Dalla Lana School of Public Health, University of Toronto
Former President, Public Health Ontario
Joel Kettner, MD, MSc, FRCSC, FRCPC
Former Chief Public Health Officer, Province of Manitoba
Onye Nnorom, MDCM, CCFP, MPH, FRCPC
President, Black Physicians' Association of Ontario
Associate Program Director, Public Health and Preventive Medicine Residency Program
Dalla Lana School of Public Health, University of Toronto
Brian Postl, MD, FRCPC
Dean, Rady Faculty of Health Sciences and Vice- Provost, Health Sciences, University of Manitoba
Former President, Winnipeg Regional Health Authority
Neil Rau, MD, FCPC
Infectious Disease Specialist and Medical Microbiologist
Assistant Professor, University of Toronto
Richard Reznick, MD, FRCSC, FACS, FRCSEd (hon), FRCSI (hon), FRCS (hon)
Professor of Surgery and Dean Emeritus, Faculty of Health Sciences, Queen’s University
Susan Richardson, MDCM, FCRPC
Professor Emerita, University of Toronto
Richard Schabas, MD, MHSC, FRCPC
Former Chief Medical Officer of Health, Province of Ontario
Former Chief of Medical Staff, York Central Hospital
Gregory Taylor, MD, FRCPC
Former Chief Public Health Officer of Canada
David Walker, MD, FRCPC
Former Dean of Health Sciences, Queens University
Chair, Ontario’s Expert Panel on SARS, 2003
Catharine Whiteside, CM, MD, PhD, FRCPS(C), FCAHS
Executive Director, Diabetes Action Canada - CIHR SPOR Network
Emerita Professor and Former Dean of Medicine, University of Toronto
Trevor Young, MD, PhD, FRCPC, FCAHS
Professor of Psychiatry
Dean, Faculty of Medicine and Vice Provost, Relations with Health Care Institutions
University of Toronto
Dealing With COVID-19: A Balanced Response
July 6, 2020
COVID-19 is a serious public health threat and will remain so until we have a universally available safe and effective vaccine or similar medical treatment. There have been many deaths due to COVID-19 and every single one represents a tragic outcome. However, in overall population health terms COVID-19’s direct impact on premature mortality is small. While those under the age of 60 account for 65% of cases, they represent just 3% of deaths. With ready access to health services, severe outcomes can be averted in those who do not have pre-existing risk factors.
In March 2020, unprecedented public health measures were implemented in Canada in response to the rapid rate of growth of cases and the potential threat to health system. Because of the potential for exponential growth in cases and the situation in other parts of the world our governments took these actions that applied to the entire population in order to protect our health care system. These interventions were meant to buy the time necessary to develop a longer-term response. They should not be used as a means of eradicating the disease.
While some countries have been successful in suppressing the disease, most continue to see sporadic cases and outbreaks. Only a few countries, primarily island nations, appear to have eliminated the disease, but it is uncertain how long those countries can completely isolate themselves from the rest of the world.
The public health measures did protect our health care system, to the point that Canada had excess capacity. Our leaders and public health authorities had to use strong language to support universal acceptance of these measures. As a result, many Canadians have become fearful of COVID-19 and are worried about the impact of working, seeking routine and preventative medical care, participating in religious and cultural events, interacting with their family and friends, using public transportation, shopping and other normal activities.
COVID-19 control is an important public health priority but it is not the only nor the most important challenge to the health of people in Canada. We need to examine the broad social determinants of health and their impact on citizens, particularly with an equity lens, as the consequences of the public health measures have not been shared equally in society. Those in lower income groups, Black and other racialized groups, recent immigrants and Indigenous people are bearing disproportionate burden. The public health efforts must take account of the impacts of both the disease and the consequences of the control measures on all segments of the population.
The fundamental determinants of health - education, employment, social connection and medical and dental care - must take priority. Measures for COVID-19 control need to accommodate these health determinants. Children need to go to interact with their peers, in child care, schools, sports and social activities, and summer camps. Adults need to go to work. Family and friends need to meet
The societal costs of maintaining these public health measures, even with some gradual relaxation, are too high. Canadians are missing scheduled medical appointments and surgeries, which will lead to increased deaths. There are significant challenges for our young with impact on early childhood development, one of the strongest predictors of life-long health and social outcomes. Education is compromised. There are increases in domestic violence, alcohol and drug intake, and food insecurity. The economic consequences are huge. This leads to increased unemployment which is related to increased deaths. And the toll on mental health is just beginning to be felt. Personal concerns about the disease, cases and deaths in friends and family, loneliness and isolation, worries about jobs and finances, parents having to juggle childcare and general insecurity are leading to increased levels of anxiety, depression and stress.
We need to shift from a mindset of attempting to eradicate this disease, which is not feasible and will lead to continued devastation of our society, to a new goal.
Our new goal: Minimize the impact of COVID-19 using methods that are practical, effective and compatible with our values and sense of social justice. We need to focus on preventing deaths and serious illness by protecting the vulnerable while allowing society to function.
Elimination of COVID-19 is not a practical objective for Canada until we have a vaccine. We need to accept that there will be cases and outbreaks of COVID-19. We should mitigate the effects of the disease with measures that are equitable, sustainable and acceptable. This includes testing and contact tracing, and ensuring that health services with access to the latest treatments are available for those who contract the disease.
Those at highest risk of severe consequences need to be offered effective protection from COVID-19, particularly those in long-term care institutions, but this protection must be respectful of their autonomy and allow them a reasonable quality of life.
Aside from the outbreaks in long-term care institutions, some of the most significant have been in other congregate living settings (homeless shelters, prisons, dormitories for temporary foreign agriculture workers) and work settings such as meat packing plants. Appropriate protections and supports are needed in such settings.
COVID-19 control must be balanced with basic human rights. People need to be empowered to make informed choices about their own lives and the level of risk they are prepared to accept. Universal public health measures are appropriate only when they are truly necessary, supported by strong evidence, and when there are no other alternatives.
Recommendations
Carefully reopen schools, businesses and health care. Allow gatherings of friends and family. Provide practical guidance that allows citizens and institutions to operate safely and effectively. Restore public confidence that it is safe to go out, that appropriate precautions are in place, and conditions will be closely monitored.
Develop clear control plans for future outbreaks or resurgence of disease that are risk-based and focused so further universal lockdowns are not necessary.
Improve our disease surveillance so that we have an accurate picture of disease activity to make timely decisions and provide useful advice to Canadians. Ensure that public health has the resources to conduct timely and effective testing and contract tracing.
Provide clear guidance on appropriate use of viral (diagnostic) and antibody (serology) testing for health care providers, employers and community organizations. While testing is a critical element for control of COVID-19, it has to be done in a smart way. Indiscriminate testing, for example, daily testing of all employees in an office setting is less effective than testing of those with greater exposure to the general public.
Assess community risk in applying infection control approaches in different settings. Procedures that are appropriate for a hospital, with high risk of exposure, are not necessary across all of society. Control measures need to be evidence-based and address the level of risk in a particular setting and community. Measures should take account of costs and benefits at the individual and community level using a social determinants of health model and applying an equity lens.
Assess the appropriateness of recommendations for physical distancing from a risk benefit perspective. Where risk of community transmission is very low, the absolute benefits of physical separation are negligible, particularly if good hygiene is practiced and individuals with symptoms stay home.
Reassess quarantine and isolation periods based on current evidence. Strategies that use testing to further reduce this period should be examined. Review the restrictions on non-essential travel to all parts of the world. Travel should be restarted to countries where there is little community transmission.
Be clear on when the use of medical and non-medical masks is recommended. When advice varies based on local epidemiology, provide clear evidence-based criteria for decision-making. Any requirements for mandatory masks must be based on strong evidence with clear specification of where they are most appropriate (close quarters, congregate living settings, etc).
Improve infection prevention and control in long-term care as deaths have come mainly from a break down in these practices within some facilities.
Canadians must be better informed about their true level of risk from COVID-19. An accurate accessible risk assessment tool is a priority. This will help empower people to make informed decisions about how they choose to lead their lives. Help people understand and manage their fear and anxiety.
Provide support for vulnerable people living in the community who choose to isolate when the disease is active. Some individuals, even though at risk for severe disease, may wish to make informed decisions to carry on with normal life. Such choices should be respected and supported.
Ensure there are adequate supports for those individuals that have been adversely affected by COVID-19, or the consequences of the public health measures. In particular, support for mental health and addictions is essential as the potential toll on the population is massive.
In stark contrast to the MIT researchers' grave projections, Stanford University biologist and Nobelist in chemistry Michael Levitt and his team argue in their preprint study that the pandemic is essentially self-flattening and is already subsiding in much of the world. The Stanford team tracks data on cases and deaths from COVID-19 outbreaks at 3,546 locations around the world. They find that after an initial steep rise in each outbreak that the rates of diagnosed infections and deaths generally begin to decline at a steady, almost linear, pace.
As Medical News explains, the Stanford team created graphs for each outbreak using data that takes into account four trends. The first three are the total case number, the total death number, and their ratio, that is, the death rate. The fourth measure is the ratio of the total cases (or deaths) for today divided by the same ratio of yesterday. This is known as the "fractional change function." This analysis revealed that, instead of growing exponentially, the epidemics in many regions are actually slowing down exponentially with time. (Interestingly, the daily rate of U.S. COVID-19 deaths has been slowing down, but the daily number of diagnosed cases has started growing once again.) So how does Levitt account for the epidemic's self-flattening behavior?
Levitt and his colleagues argue, "The existence of invisible cases of individuals who are mildly symptomatic and, therefore, not counted as confirmed cases may explain the non-exponential behavior of COVID- 19: the known cases cannot easily find people to infect as the hidden invisible cases have already infected them." They also acknowledge that changes in behavior such as the wide adoption of social distancing and mask-wearing would also contribute to flattening the epidemic.
"Imagine I had a confirmed case of COVID. Unbeknownst to me, a declared case, I've also infected my friends, my kids, people near me. And this means on the first day, I can infect people, but then the next day, I can't find people so easily to infect," explained Levitt in a May 4 interview with The Stanford Daily. "In some ways, what's happening is that invisible cases are having a hard time finding people to infect, because the invisible cases have already infected them. Since then, there's been a lot of extra findings about maybe we have some natural immunity to the virus as well."
Basically, Levitt is arguing that the various regions his team is tracking are reaching COVID-19 herd immunity much faster and at lower levels than most epidemiologists think likely. While most epidemiologists believe that the COVID-19 herd immunity threshold is somewhere around 60 to 70 percent, "I personally think it's less than 30 percent," said Levitt in the interview. Recent very preliminary research in fact suggests that several regions have already achieved herd immunity to COVID-19.
Based on his analysis, Levitt projected on May 4 that COVID-19 deaths in Sweden should plateau in the next few weeks at between 5,000 to 6,000. As of July 1, the Johns Hopkins COVID-19 dashboard reports 5,411 COVID-19 deaths in Sweden. Levitt also predicted on May 4 that the number of deaths in the rest of the world will reach a peak sometime around the next 8 to 14 weeks. It's been nine weeks since his prediction.
According to Worldometers data, global daily COVID-19 deaths peaked in April and have since been on a plateau of around 4,000 per day for the last couple of months. If that daily death rate is sustained through March of next year that would just about match the global projections made by the MIT team.
Will the COVID-19 pandemic grind grimly on racking up ever more deaths as the MIT researchers predict or will it moderate and recede mildly into the background of daily life as the Stanford team forecasts? We should know which of the statistical numerologists is the more accurate by the end of the summer.
No local institution is more important than our public schools. Even as COVID-19 cases continue to spike throughout Florida and Tampa Bay, school officials need to find a way for schools to open safely next month, with masks, social distancing, lower capacity on school buses, distance-learning as appropriate and whatever else is necessary to cut the danger to responsibly manageable levels. They also must plan for what happens when students and staffers inevitably test positive. Shutting down and starting over is not the answer. Scaling back could be.
Schooling is too important to get wrong, and too many students have effectively had little to no education since campuses closed in the spring. The students who most need a structured learning environment — that is, a classroom of some kind — are the ones being left behind. Yes, it’s important to keep students and staffers safe, but we cannot let already disadvantaged and struggling students fall even farther behind.
This cannot be a binary choice between safety or schooling. They are equally important, and neither is optional.
Guiding principles — not hard and fast mandates — are key, as is flexibility. If students and staffers don’t feel safe, the entire enterprise will collapse. Learn from other states. California, for example, will keep school buses at low capacity and have students load from the back to front and then disembark from front to back. Lots of simple practical solutions can combine to keep the risk lower. Computer modeling led by University of South Florida professor Tapas Das for all of Miami-Dade (not just schools) showed that face masks and aggressive contact tracing, combined with the existing Phase II reopening, could have effectively ended the outbreak in that county by late September. But that didn’t happen. Policy choices matter.
Also, school officials can learn from what we are fast discovering about the coronavirus, whom it affects and how, and how it is and isn’t transmitted. We know so much more than we did in March. Younger kids, for example, may not be super spreaders, as once feared. Open air is far safer than closed spaces. Social distancing really works, as do masks, so long as everyone wears them properly. And we’ll know more next month than we do now. Plans should adapt accordingly. In that way, it was wise for Hillsborough County superintendent Addison Davis to listen to experts and change his mind this week to require, not merely suggest, that most teachers and students wear masks when classes resume next month.
In January, vaccine researchers lined up on the starting blocks, waiting to hear a pistol. That shot came on January 10, when scientists in China announced the complete genetic makeup of the novel coronavirus. With that information in hand, the headlong race toward a vaccine began.
As the virus, now known as SARS-CoV-2, began to spread like wildfire around the globe, researchers sprinted to catch up with treatments and vaccines. Now, six months later, there is still no cure and no preventative for the disease caused by the virus, COVID-19, though there are glimmers of hope. Studies show that two drugs can help treat the sick: The antiviral remdesivir shortens recovery times (SN: 4/29/20) and a steroid called dexamethasone reduces deaths among people hospitalized with COVID-19 who need help breathing (SN: 6/16/20).
But the finish line in this race remains a safe and effective vaccine. With nearly 180 vaccine candidates now being tested in lab dishes, animals and even already in humans, that end may be in sight. Some experts predict that a vaccine may be available for emergency use for the general public by the end of the year even before it receives expedited U.S. Food and Drug Administration approval.
19 is both startlingly unique and painfully familiar
Velocity might come at the expense of safety and efficacy, some experts worry. And that could stymie efforts to convince enough people to get the vaccine in order to build the herd immunity needed to end the pandemic.
“We’re calling for transparency of data,” says Esther Krofah, executive director of FasterCures, a Washington, D.C.-based nonprofit. “We want things to accelerate meaningfully in a way that does not compromise safety or the science, but we need to see the data,” she says.
Getting a head start
Traditionally, vaccines are made from weakened or killed viruses, or virus fragments. But producing large amounts of vaccine that way can take years, because such vaccines must be made in cells (SN: 7/7/20), which often aren’t easy to grow in large quantities.
Getting an early good look at the coronavirus’s genetic makeup created a shortcut. It let scientists quickly harness the virus’s genetic information to make copies of a crucial piece of SARS-CoV-2 that can be used as the basis for vaccines.
That piece is known as the spike protein. It studs the virus’s surface, forming its halo and allowing the virus to latch onto and enter human cells. Because the spike protein is on the outside of the virus, it’s also an easy target for antibodies to recognize.
Researchers have copied the SARS-CoV-2 version of instructions for making the spike protein into RNA or DNA, or synthesized the protein itself, in order to create vaccines of various types (see sidebar). Once the vaccine is delivered into the body, the immune system makes antibodies that recognize the virus and block it from getting into cells, either preventing infection or helping people avoid serious illness.
Using this approach, drugmakers have set speed records in devising vaccines and beginning clinical trials. FasterCures, which is part of the Milken Institute think tank, is tracking 179 vaccine candidates, most of which are still being tested in lab dishes and animals. But nearly 20 have already begun testing in people.
As America comes back, examining different sectors provides key insights as to those that may be integral to the rebound. What we learn from this process allows the nation not only to return to work but also sketch a roadmap for future job growth, environmental stewardship and safety.
Among the sectors leading the way is the design and construction community. This industry is a key component of any recovery because its supplies services to a cross-section of America, both public and private sector, from road, bridges, dams, to power grids, manufacturing, industrial, water treatment and residential. A newly-released APCO Insight survey indicates that 95 percent of the U.S. public thought it very or somewhat important “for the U.S. to continue to invest in its infrastructure” emerging from the shutdown.
As an example, the construction industry is responsible for the creation and maintenance of key sustainable environmental projects; which if cancelled or delayed could potentially mean lack of remediation to water, air and other hazardous challenges that may risk the well-being of the public. Therefore, finding ways to keep the workforce safe and the projects continuing has important societal benefits.
Consequently, the architectural, engineering and construction industry as a whole is a broad barometer of the nation’s health and prosperity; while also playing a vital role with regard to global competitiveness, economic growth, environmental sustainability, and national security, as well as assuring the extraordinary quality of life enjoyed by so many Americans.
Moreover, a robust construction and design industry can help lead the nation out of the current difficulties with a wide array of skilled craft trades and/or professional positions. As a highly labor-intensive sector of our economy, the industry offers good paying jobs and career paths in communities of all sizes across the country; including prime opportunities for women, minority populations, and those who are economically disadvantaged. Most positions don’t require four-year college degrees, and some will pay while you are an apprentice or trained on the job. The same APCO survey finds 90 percent of Americans agreed “apprenticeships & credentialing programs can lead to good paying jobs and career paths.”
APCO’s new polling results also show high concern among Americans due to COVID19’s impact on small businesses – even more so than the impact on the overall economy. (64% vs. 55% very concerned). Construction, architectural and engineering companies are predominantly small business entities. These companies are part of the fabric of main street America and represent a vital part of the nation’s economy for which the public is worried.
America’s handling of the coronavirus.
The words “utter disaster” are used, and Williams, an expatriate, contrasts America’s response to that of France, where he currently lives.
“As Donald Trump’s America continues to shatter records for daily infections, France, like most other developed nations and even some undeveloped ones, seems to have beat back the virus,” Williams writes.
To be sure, the US response to the coronavirus was far from perfect (more on that later). But the article shows one of the challenges with this pandemic: even as more data is acquired, the picture doesn’t always get clearer.
In some ways, COVID-19 data are like a Rorschach blot from which writers, politicians, and experts can glean whatever conclusions they wish to find. Take Sweden, where daily COVID-19 deaths recently reached zero.
According to Newsweek editorial director Hank Gilman, Sweden’s “lighter touch” approach was a failure because seven times as many people died there than in neighboring Scandnavian countries such as Finland and Norway. He is not alone in the assessment.
On the other hand, Sweden suffered far fewer deaths per capita than several European neighbors that instituted strict lockdowns—including Belgium, Italy, Spain, and the United Kingdom—and has avoided some of the economic fallout other nations have endured. Unlike other countries, its currency is growing stronger.
Indeed, Sweden’s death rate is remarkably close to that of France, which Williams praised as a model in contrast to the “utter disaster” in the US. However, the US actually has a lower per capita death rate than both Sweden and France—at least for now. (While it’s true COVID cases are on the rise again in the US, deaths recently reached three-month lows.)
This raises questions about how we measure success in the age of COVID-19. While most attention is being paid to rising case numbers, death tolls would seem to be the most important metric. While US deaths per capita (401/1M) put the country among the ten highest in the world—ahead of France and Sweden, but just below the Netherlands—those numbers also don’t tell the entire story.
Few may have noticed that 42 percent of all COVID deaths in the US come from just three states—New Jersey, New York, and Massachusetts. These three states account for nearly 56,000 of the nearly 133,000 deaths in the US, even though they represent just 10 percent of the population. If these three states are excluded, the US suddenly finds itself somewhere in between nations such as Luxembourg (176/1M) and Macedonia (166/1M), where some of the better fatality numbers in Europe are found.
Why have New York, New Jersey, and Massachusetts suffered so much more than other US states? We don’t yet know the answer to that question, but evidence suggests it could be policy related.
New York Gov. Andrew Cuomo earlier this year received a great deal of criticism when the state’s policy of prohibiting nursing homes from screening residents for COVID-19 came to light. Cuomo eventually reversed that decision under intense criticism from public health experts and trade group leaders.
This week, the New York State Department of Health issued a report that concluded 6,326 COVID-positive residents were admitted to nursing homes between March 25 and May 8 as a result of the order.
”The data shows that the nursing home residents got COVID from the staff, and presumably, also from those who visited them. Unfortunately, we did not understand the disease early on, we did not realize how widespread it was within our community, and therefore, it was able to be introduced into a vulnerable population,” said New York Health Commissioner Dr. Howard Zucker.
The report, however, also claimed that “most patients admitted to nursing homes from hospitals were no longer contagious when admitted and therefore were not a source of infection … [and] … nursing home quality was not a factor in nursing home fatalities.”
The report cites the high nursing home fatality rates of Massachusetts and New Jersey as additional evidence that New York was not an outlier in nursing home deaths.
“...an examination of fatalities in our neighboring states—despite having populations much smaller than New York’s—illustrates fatalities at these facilities were not a New York-specific phenomenon: Connecticut reports 3,124 deaths in these facilities, New Jersey reports 6,617, and Massachusetts reports 5,115, to New York’s 6,432 fatalities.”