Could nursing home deaths skew our age related risk assessment of Covid-19?

[Tom Rinaldo]

I don't doubt that advancing age is a very relevant variable in assessing who is most at risk of dying from Covid-19. But as I have come to appreciate how disproportionately high a percentage of Covid-10 deaths involve residents of nursing homes, I am starting to wonder if more nursing home deaths should be understood as resulting from a variable other than age: concentrated viral load exposure from close quarters work and/or habitation. The living conditions generally present in most nursing homes are conducive to viral incubation: Large numbers of people living in closed and close proximity with a rotating crew of staff moving from one to another between them, along with group dining etc.

When we look at Covid-19 lethality charts broken down by age, they include nursing home deaths concentrated in older age groups. As a result of the proliferation of nursing homes in our society, a higher percentage of the elderly are in group living situations compared to most other age groups. Again, I do not doubt that the elderly are on the whole much more susceptible to Covid-10 death than younger age groups, but could nursing home deaths be magnifying that conclusion for reasons not always age related?

Clearly viral load (degree of concentrated exposure) is a contributing factor to Covid-19 deaths, as reflected in the relatively high number of health care workers of younger ages who have succumbed to Covid-19. i would be interested in seeing a statistical study of the number of deaths from Covid-19 of prison inmates and/or navy sailors (both demographically younger age groups living in confined quarters) compared to nursing home residents on one hand, and the general public on the other. College dorm students could be another study group, except that most dorms were emptied at an early stage of this pandemic.

[The Magistrate]

1. An Interesting Thought, Sir

It would seem a good candidate for professional study.

[forthemiddle]

2. I also wondered about DNR orders and nursing homes

When my Mom was admitted to a nursing home for short term rehab, the first thing they asked about was a DNR order.
If a NH patient has one on file, are the unlikely to be admitted to a Hospital, and thus raising there chances of dying?

[JudyM]

3. Yes.

Yes, their immune systems are not as strong so less viral load is necessary. Yes, their comorbidities open doors for complications. Possibly also their use of ACE inhibitors or other meds impacts the data. But congregate living has to be an independent factor. Regardless of how well the facility is cleaned, regardless of how assiduous the staff is about masking, it takes very little for the virus to get in and get around, whether from mail or incidental exposure by one of the food service folks or other staffers.

SARS-1 was found to have infected people through HVAC systems. Like SARS-1, this one is airborne. All these facilities could be putting in HEPA filters, increasing intake of outdoor air, using humidifiers and looking into use of UVC lighting at least in the HVAC system.

[crickets]

4. K&R for the post and the discussion.

[Tom Rinaldo]

5. Thanks. I think it's potentially important because of the common perception that young folk are safe

They are safer from risk of death, true, but if the variable of dense co-habitation risk is adequately adjusted for regarding nursing home deaths it might show that the risk associated with older age as a stand alone variable is less pronounced than it is widely assumed to be. Which would mean that younger people may not be quite as invincible as they might like to think they are. I've seen a lot of public service announcements asking younger people to observe social distancing in order to protect those more vulnerable than themselves, and in an indirect way that sends an unspoken message that although they are safe, others aren't. I've always felt a bit uneasy about that type of messaging.