November 2015

The New York State Task Force on Life and the Law and the New York State Department of Health release “VENTILATOR ALLOCATION GUIDELINES” with accompanying letter from Howard A. Zucker, commissioner of health, and member of the task force. The report:

• Recommended legislation giving authority to the New York State commissioner of health “to adopt a modified medical standard of care specific to the emergency, coupled with civil and criminal liability protections and professional discipline protections for all health care workers and entities who provide care in a pandemic emergency.”
• Provided an estimate of need for ventilators for 89,610 persons during a six-week severe outbreak of influenza, concluding that “there will not be enough ventilators in the State to meet the demand. A clinical ventilator allocation protocol will need to be implemented to ensure that ventilators are allocated in the most efficient manner to support the goal of saving the greatest number of lives. …” 
• Concluded that “The duty to plan is the responsibility of government to plan for a foreseeable crisis.”
• Cited the annual U.S. influenza toll, including “a large number of the very young and elderly (i.e., more vulnerable populations) die every year”
• Numbered the ventilators in New York State:
  7,241 ventilators in acute care settings
  1,750 ventilators stockpiled, available “at all times”
  Total of 8,991 ventilators in New York
• Stated “there are no current plans to buy enough ventilators for the most severe model” of a pandemic. The reasons: There was “the need to maintain adequate funding for current and ongoing health care expenses.”
  The report anticipated a severe staffing shortage during a pandemic and said “purchasing additional ventilators beyond a threshold will not save additional lives, because there will not be a sufficient number of trained staff to operate them.”
• Noted the 1,902 ventilators in chronic care facilities and nursing homes. These ventilators “may eventually enter the wider pool” of ventilators when those chronic care patients become ill enough to be transferred to acute care hospitals but are deemed ineligible for ventilator therapy there.

Feb. 27, 2019

The Democrat & Chronicle of Rochester reports: “The number of residents in New York aged 65 and older grew 26 percent over the past decade compared to an overall population that grew just 3 percent over the same period, a report Wednesday found. ...

“Nearly one in six New Yorkers was 65 and over, representing 16 percent of the total population—more than any other age group, according to the report's review of census data.”

March 7, 2020

Gov. Cuomo declares a State disaster emergency in New York to contain the spread of COVID-19.

March 10, 2020  

State Health Commissioner Zucker: “As we see the number of cases continue to rise based upon close contacts with persons who are positive for COVID-19, there is a particular need to reduce the opportunity for further close contacts. ... “

March 12, 2020 

Gov. Cuomo: “This means no visitors in a nursing home. If you care for someone in a nursing home, the last thing you want to do is endanger them.”

March 13, 2020

President Trump declares a national emergency for the COVID-19 pandemic. 

March 20, 2020 

Deadline.com: "A Major Disaster Declaration has been issued for New York by the Federal Emergency Management Agency (FEMA). The move will unlock access to aid from its Disaster Relief Fund, a critical move as new confirmed coronavirus cases soar in the state."

March 24, 2020 

Gov. Cuomo declares: “My mother is not expendable. And your mother is not expandable. … We’re not going to accept a premise that human life is disposable. We’re not going to put a dollar figure on human life,” Cuomo said. “We are going to fight every way we can to save every life that we can.”

March 24, 2020

Jamanetwork.com: “Nursing Homes Are Ground Zero for COVID-19 Pandemic," by Michael L. Barnett and David C. Grabowski

“Why are nursing homes so vulnerable to COVID-19? Nursing home residents are typically older adults with high levels of chronic illness and impairment. As such, they are particularly susceptible to severe complications and mortality from COVID-19. Unlike a hospital, a nursing home is someone’s home. Often, residents live in close quarters with one another, so it can be quite challenging to move or quarantine residents once they are sick. Moreover, caregivers move from room to room assisting residents, thus providing a further challenge in limiting the spread of infections. Compounding the risk, many staff do not have paid sick leave, so they may continue to work even while experiencing symptoms. Many staff and residents also do not consistently wash their hands, a perennial problem in health care facilities, and thereby spread the virus. …

“… In an epidemic like the COVID-19 outbreak, our response will only be as strong as the weakest, most vulnerable link.”

March 25, 2020

New York Department of Health memo to "Nursing Home Administrators, Directors of Nursing, and Hospital Discharge Planners": 

"Advisory: Hospital Discharges and Admissions to Nursing Homes

 … No resident shall be denied re-admission or admission to the NH solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.

Information for healthcare providers on COVID-19 is readily available on the New York State Department of Health public website at https://coronavirus.health.ny.gov/information-healthcareproviders. As always, standard precautions must be maintained, and environmental cleaning made a priority, during this public health emergency. 

Critical personal protective equipment (PPE) needs should be immediately communicated to your local Office of Emergency Management, with the appropriate information provided at the time of request. Requests MUST include: 

• Type and quantity of PPE by size; 
• Point of contact at the requesting facility or system; 
• Delivery location;
• Date request is needed to be filled by; AND 
• Record of pending orders.”

March 30, 2020

Boston.com: "What explains COVID-19’s lethality for the elderly? Scientists look to ‘twilight’ of the immune system," by Sharon Begley, STAT

“Researchers on Monday announced the most comprehensive estimates to date of elderly people’s elevated risk of serious illness and death from the new coronavirus: Covid-19 kills an estimated 13.4% of patients 80 and older, compared to 1.25% of those in their 50s and 0.3% of those in their 40s.

“The sharpest divide came at age 70. Although 4% of patients in their 60s died, more than twice that, or 8.6%, of those in their 70s did, Neil Ferguson of Imperial College London and his colleagues estimated in their paper, published in Lancet Infectious Diseases.

May 5, 2020

PNAS:  “Demographic science aids in understanding the spread and fatality rates of COVID-19”:

“Currently, COVID-19 mortality risk is highly concentrated at older ages, particularly those aged 80+ y.”

May 10, 2020 

NBC News: “New York Gov. Andrew Cuomo issued a series of new rules for nursing homes in hopes of curbing the spread of the coronavirus and protecting the health and safety of the state’s most vulnerable population.

Since the start of the pandemic, more than 5,300 New Yorkers living in nursing homes have died from the virus, that's according to a tally from the Associated Press.

Hospitals cannot release patients to nursing homes in New York unless the patient tests negative for the virus, Cuomo said Sunday. The governor's announcement is a reversal of sorts from a March order by the state's health department requiring nursing home to accept recovering patients.”

May 21, 2020

CBS New York: “New York has 40% more nursing homes residents than Florida, but 700% more nursing home deaths.”

As of June 3, 2020, New York government statistics:

Nursing Home and ACF COVID Related Deaths Statewide reported with this caveat:

“*The 6/3 numbers displayed are a result of a comprehensive accounting of current and retrospective data, provided by facilities. This data captures COVID-19 confirmed and COVID-19 presumed deaths within nursing homes and adult care facilities. This data does not reflect COVID-19 confirmed or COVID-19 presumed positive deaths that occurred outside of the facility. Retrospective data reporting dates back to March 1, 2020.”

Author tallies of data presented at https://www.health.ny.gov/statistics/diseases/covid-19/fatalities_nursing_home_acf.pdf :

COVID Confirmed Deaths at nursing homes            3,350

COVID Presumed Deaths at nursing homes              2,718

COVID Confirmed Deaths at adult care facilities         117

COVID Presumed Deaths at adult care facilities           52

TOTAL                                                                              6,237

By June 4, 2020:

New York State has reported 169,213 COVID-19+ cases, and 8,230 deaths.  New York City is reported separately as having 201,806 COVID-19+ cases, and 21,688 deaths.

Author calculations of COVID-19 deaths in New York:

6,237 NH/ACF deaths X 100 

21,688 NYC + 8,230 NY State deaths

The rate is 20.85%.  That means that 20.85% of COVID-19 deaths in New York are deaths of residents of nursing homes or adult care facilities.  That is clearly an underestimate, due to the fact that any NH or ACF resident who dies elsewhere is not counted as an NH/ACF death.

As more than one mentor has taught me, “Listen to the words, yes, but watch the hands.”

—Dr. D. Joy Riley is executive director of the Tennessee Center for Bioethics & Culture