COVID Update April 10: I spent the day in conversations w some of the people on society’s margins. Criminal justice, nursing homes, people w disabilities. And on NY and NJ.

Going on @maddow on @maddow at 9:25E or so. Will tweet soon after if interested, follow here. 1/
OK. Let’s get into this. The people America forgets. I’m really grateful that @maddow not only started pushing on this & had me on to discuss, but actually did the reporting to add up what’s going on. 2200 deaths in nursing homes based on what’s been reported. 2/
So what’s going on? I called 2 nursing homes, someone who lost a parent in a nursing home, and someone who provides nurses to nursing homes.

1.5 million Americans. Many over 80. Most cut off from their families. 1500 homes. Many mom & pops, most with shoddy safety records. 3/
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 4/
-No resources to pick up bodies for days
-Management overwhelmed & unprepared
-Infected staff, no testing for staff
-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

5/
-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 & cleanliness challenging
-infection causing audible distress 6/
My friend whose father passed away yesterday reported that there wasn’t any separation between his father & other residents 7/
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.8/
In 2016 Obama created regulations based on years of study to limit the use of anti-psychotics, improve infection control & increase safety.

In 2017 to great fanfare, the Trump Admin ripped them up, decrying the 1100 pages of regulation as an example of red tape cutting.9/
I signed the regulations that were since eliminated.

Deregulation. 10/
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.

@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.11/
I just told her what I would do if I were still there:
-Test every staff person within the next week & PPE 4 all
-Go to Congress for $ for telemedicine, hospice & get CDC to create rules to bring in help/mental health support
-Full transparency & daily calls w all operators 12/
Next stop in the tour veterans and the VA (if you need a breather, take one)
-Over 3000 cases in the VA
-1/3 are staff!
-7 VA staff have died
-Lack of PPE
-Only 20% w plans to share resources with hospitals in community who are short (I’ve been told they have spare vents)13/
The VA itself (not the docs but the political staff) “nowhere to be found, completely fumbling”

I heard this from only one person so understand it to be just one view. I really don’t know. 14/
If nursing homes and the VA are bad, jails & prisons are a breeding ground for COVID-19. To pick another place where most people don’t care. Where it’s “not me.” 15/

nytimes.com/2020/04/08/us/…
People are being kept in both the criminal & immigration detention centers in unsafe conditions. @verainstitute contacted me. They put together a guide for these systems to prevent CV spread. We are due to talk in a couple days. I will report back.16/

vera.org/publications/c…
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. 17/
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. 18/
Consider reading this blog from my colleague @NatalieEPD at @USofCare. 19/

twitter.com/aslavitt/statu…
In NY hearing that FQHCs and non-profit social service agencies are shuttering or very close. People who deliver meals & provide housing & services to the needy. 20/
So much more happened today. Worked on finding vents for NJ. Got a good update on PPE supplies. Worked on potentially exciting technologies for contact tracing if we can make it to that point. Reviewed a package for Congress....But... 21/
It all felt abstract compared to the suffering is happening all around that I can’t see. That I don’t really know how to help. I feel like a bystander. I feel some amount of shame.

No less hope for most of us than ever. But those we usually leave behind we are devastating.22/
And it is happening too quickly and with too much other noise & a certain amount of fear for our own safety to call attention to others’ suffering.

People who care can’t seem to help. People who can help don’t seem to care.

Time to do better.end/

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