The People Most Vulnerable to the Coronavirus Are Not Being Protected

A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services

Andy Slavitt
Medium Coronavirus Blog


Photo by Lauren A. Little, MediaNews Group via Getty Images

Pulled from my daily COVID-19 updates on Twitter

I spent the day in conversations with some of the people on society’s margins. Criminal justice, nursing homes, people with disabilities. The people America forgets. I’m really grateful that Rachel Maddow not only started pushing on this and had me on her show to discuss, but actually did the reporting to add up what’s going on.

There are roughly 1,500 nursing homes (many of which are mom and pops homes, most with shoddy safety records) which care for 1.5 million Americans. Many over 80. Most cut off from their families. 2,200 deaths in nursing homes based on what’s been reported.

So what’s going on? What did I hear? Call these anecdotes collected from probably 30 nursing homes:

  • Staff infected, not tested
  • Many staff going from home to home, not tested
  • Many with no gear
  • Hospitals refusing to take patients
  • No resources to pick up bodies for days
  • Management overwhelmed and unprepared
  • Physicians not permitted to enter almost any place I talked to
  • Short staffed because some nurses who cover more than one aren’t let in
  • little to no money to invest in improvements

And most importantly:

  • Incredible loneliness
  • Overburdened staff can’t spend time
  • Family can’t visit
  • Sitting in chairs all day long
  • Assistance with bathroom and cleanliness challenging
  • Infection causing audible distress

My friend whose father passed away yesterday reported that there wasn’t any separation between his father and other residents. Nursing homes are required to have infection control procedures. In my experience, most are very poor at it. However, senior care centers, assisted living don’t even have those requirements.

What I’m about to say will sound partisan. In 2016 Obama created regulations based on years of study to limit the use of anti-psychotics, improve infection control and increase safety. In 2017 to great fanfare, the Trump Admin ripped them up, decrying the 1,100 pages of regulation as an example of red tape cutting.

When an infection hits 1 resident of a nursing home with 100 residents, many will get infected. The majority of them are at risk of dying. Rachel Maddow asked me tonight if anything could be done or if it was too hard. There is nothing more worth doing than saving these lives. I just told her what I would do if I were still there:

  • Test every staff person within the next week & PPE for all
  • Go to Congress for money for telemedicine, hospice and get CDC to create rules to bring in help/mental health support
  • Full transparency and daily calls with all operators

Now let’s talk about veterans and the US Department of Veterans Affairs:

  • Over 3000 cases in the VA
  • 1/3 are staff!
  • 7 VA staff have died
  • Lack of PPE
  • Only 20% with plans to share resources with hospitals in community who are short (I’ve been told they have spare ventilators)

I heard this from only one person (so understand it to be just one view) that the VA itself — not the doctors, but the political staff — are “nowhere to be found, completely fumbling”.

If nursing homes and the VA are bad, jails and prisons are a breeding ground for Covid-19. It’s another place where most people don’t care about those at risk. Where it’s “not me.”

People are being kept in both the criminal and immigration detention centers in unsafe conditions. We have been very concerned in recent weeks about the talk of “ethical decisions” on who might get a ventilator. I have no envy for institutions that have to contemplate these things. But the policies land in the wrong direction. They are particularly worrisome for people living with disabilities. The notion of valuing the “quality” of someone’s life is a far cry from our ideals as a nation. This is not the time to compromise. It is exactly the time to be better.