False Hero of the Pandemic

The disastrous results of Andrew Cuomo’s nursing-home policy are finally revealed.

Something is rotten in the state of New York. And, as in Shakespeare’s Hamlet, it starts at the top. For the past year, New York governor Andrew Cuomo, with the aid of a credulous and adoring media, has touted his performance in combating Covid-19 and chided other states for their comparative deficiencies. He was rewarded with a lucrative book contract and an Emmy for providing “reliable information” in his news conferences. The cover has finally been blown on a prolonged and concerted effort by Cuomo and his associates to hide his policy mistakes.

Between March 25 and May 10, 2020, an advisory from Cuomo’s Department of Health (DOH) compelled nursing homes to readmit hospitalized Covid-19 patients without checking if they still had active infection. Health experts cautioned that the policy could lead to additional deaths by introducing infected people into closed facilities where those most vulnerable to the disease—the elderly and infirm—live. Cuomo’s responses ranged from the devil—aka the Trump administration—made me do it; to we didn’t force anything—facilities had discretion to turn down admissions; to “nothing to see here”—the policy didn’t increase the number of deaths; to “who cares” where they died.

Cuomo repeatedly and falsely claimed that the policy was directed by federal guidance. A July DOH report (now revised) also claimed that the nursing-home admission policy was following federal guidance that homes “should accept residents with COVID-19.” In fact, the federal guidance was permissive, not proscriptive: “A nursing home can accept a resident diagnosed with COVID-19 . . . as long as the facility can follow CDC guidance for Transmission-Based Precautions” (emphasis added).

The DOH report also claimed the state never “directed that a nursing home must accept a COVID-positive person” (emphasis in original). In fact, the March 25 advisory explicitly said that nursing homes “must comply” with the return of hospital patients. Nursing homes were instructed that they could not deny admission “based on a confirmed or suspected diagnosis of COVID-19” (underlining in original) and were “prohibited” from testing prospective admissions for Covid-19.

The DOH report asserted that Covid-19 was already present in nursing-home staff before the new policy and that since the peak of nursing-home admissions from hospitals was one week after the peak of nursing-home fatalities, transmission from staff, not the policy-directed admissions from hospitals, must be the cause of the fatalities. The report seems to discount completely the possibility that adding thousands of infected patients back into the facilities could increase transmission and death. No one claims that the policy-driven admissions caused all the nursing-home deaths, but they very likely unnecessarily increased them.

The report also maintained that the admissions were not problematic because the median length of hospital stay for nursing-home admissions was nine days, and Covid-19 patients are most likely no longer infectious nine days after symptom onset. Yet the claim about how long infectiousness lasts is based on a CDC publication stating that mild-to-moderate Covid cases are not usually infectious beyond ten days post-symptom onset, but severe cases can be infectious up to 20 days. Mild-to-moderate cases do not usually result in hospitalization. Hospitalized patients are far more likely to have had severe symptoms and remain infectious beyond nine days. In addition, a median is the midpoint of a distribution. By definition, half the nursing-home admissions had a hospital stay of less than nine days and were therefore more likely to remain infectious when they were returned to nursing facilities.

Read the full article at City Journal.