Page 14 - Layout 1

COVID-19
WHERE TO FROM HERE
continued from page 13

but is present. As we can see
from the graph, the observed,
over-the-expected deaths in ages
over 65 years, is cause for con-
cern. On the other hand, if
coders listed COVID-19 as the
“cause” of death without con-
firmation and were motivated
due to the incentives to call the
diagnosis a COVID-19, that
might explain some of the ex-
cessive death due to COVID-19.
The other issue in reporting is
due to the unnecessary deaths in
nursing homes, that have ac-
counted for over 40% of all
COVID-19 deaths. If the data
were normalized, the excessive
deaths might be closer to a fac-
tor of 1.00.
Regardless of the reason for the excess deaths, the vulnerable pop- there was worry hospitals would be overwhelmed. In the “hotspot,”
ulation is greater than age 65, and that has implications concerning New York City, the federal government responded with the New
the rest of the population younger than age 65. York National Guard and the U.S. Army Corps of Engineers ulti-
mately building an additional 2,900 beds at the Javits Convention
LESSONs LEARNED: Center. The USNS Comfort was sent to New York on March 30th
1. Co-mingling data points into one category is confusing. If flu to help mitigate the demand of patients with COVID-19 from going
deaths and non-casual COVID-19 deaths are included in the re- to the local hospitals.
porting, and policymakers then rely on the data, their decisions In New York, the governor mandated (via Executive Order) that
on how to treat the disease (i.e., the cure) may not indicate the anyone who tested positive but did not need a ventilator or ICU bed,
correct strategy forward. be transferred to a nursing home facility. Other states followed the
“wisdom” of Governor Cuomo. That move proved to be disastrous,
Why was shutting down swaths of the economy part of the strat- as consequently over 40% of COVID-19 deaths occurred in nursing
egy? The thinking in mid-March was that COVID-19 would over- homes.
whelm the hospital system. To mitigate the spread of COVID-19
and not overwhelm the hospitals, a “stay-at-home” recommendation LESSONs LEARNED:
was initiated by the CDC and mandated by governors and mayors 1. Shutting down the economy seems to have flattened the curve
across the USA. The stay-at-home orders were initially for a 30-day as intended (i.e. it slowed the increase in the rate of new infec-
period, then extended. We were told we needed to “mitigate the bur- tions).
den of disease,” and “flatten the curve”. As a corollary to ensuring 2. Wholesale shutdown of certain businesses and stopping non-es-
capacity at the hospitals, non-essential medical procedures were or- sential medical procedures had serious consequences, including:
dered stopped. This greatly impacted non-hospital medical practices. a. Delaying the health needs for millions of Americans.
It was an unfortunate trade-off that the stay-at-home order led to b. The unemployment of 40-million people.
over 40-million people becoming unemployed, and record deficit 3. The wholesale-mandate of a one-size-fits-all policy does not
spending to soften the blow to those out of work. work.
One could say that the strategies was so successful, that not only 4. Policy makers should listen to those that run the businesses; in
were hospital systems not overwhelmed, they were underwhelmed. this case, nursing home administrators pushed back on the Ex-
So much so, that many hospitals furloughed staff. There are over ecutive Order, but to no avail.
6,000 hospitals in the USA. Even with significant excess capacity, 5. New York, like many states, has a Certificate of Need demon-

14 San Antonio Medicine • July 2020