Category Archives: COVID-19

If We Forget Our COVID Pandemic History, We Will be Forced to Relive it.

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By:

Dave Kingsley

The COVID Tragedy Was System Failure that Didn’t Need to Happen

    The U.S. health care system, which includes preventative and public health, is complex and dynamic. Unfortunately, this necessary and critical system for the good of the public interest has been declining into catastrophic failure mode for at least two decades. We struggled to manage and survive a systemic collapse of the economy along with medical systems due to an inept response to a deadly pandemic during 2020 and 2021.

    Because private interests had taken precedence over the health needs of the public, approximately 2000 nursing home patients and employees had died of COVID by April of 2022.[1] They are victims of industry greed and neglect, government deregulation, and venal, corrupt, and indifferent politicians.  Given the lack of Trump Administration concern and preparation and given what happened in the Senate Intelligence Committee discussed below, it should come as no surprise that dangerous and destructive conspiracy theories abound. How easy it is to see why government failure has inflamed cynicism among such a widespread number of Americans.

    The previous administration, bureaucrats, and legislators knew that the probability of a plague was high but did not have the capacity to respond when it did happen. Successful response to a rapidly moving scourge requires: (1) a plan, (2) a strategy, (3) adequate equipment/supplies, (4) technology (5) trained personnel, and (6) and competent, honest leadership willing to implement the plan.

    The consequence of a blasé attitude on the part of government in January of 2020 was devastating. There was no plan, no strategy, adequate personal protective gear, enough ventilators, bed capacity and other equipment and supplies needed in a pandemic. 

    The question is why? Public health and infectious disease experts had been warning for decades that pandemics would grow more severe and more frequent (In 1993, global public health expert Laurie Garrett warned us of that in The Coming Plague). Indeed, since the 1980s, we have seen HIV, H1N1, SARS, and Ebola outbreaks spread across the planet. It is not as if there have not been dire health scares in our past that could have informed us of the critical need for preparedness in the future.

Who Knew What and When Did they Know it?

    The CIA was aware of something serious going on in China in December of 2019. The Chinese economy was practically brought to a halt and serious isolation practices were implemented as only an authoritarian government can implement population control. The disease quickly spread to other Asian countries. Singapore, South Korea, Taiwan, and Japan implemented extensive organized and effective prevention efforts. Singapore, South Korea, and Taiwan had prior experience with the SARS epidemic and undertook impressive campaigns to keep the outbreak from overwhelming their medical systems. They succeeded.

  Why were administration officials in the United States so sanguine about a novel virus that prompted massive public health efforts in China and other Asian nations? Even after it was known that a case of COVID had been discovered in a Washington state nursing home, the U.S. government remained unconcerned. Or did it?

    Former Senator Richard Burr, Chair of the Senate Intelligence Committee, was a leading legislative figure in the development of a national plan to thwart pandemics. He was not a neophyte in public health policy. Nevertheless, having been present at a “closed door” COVID19 briefing presented by the Trump Administration National Security Council on January 24th of 2020, he announced to the public that the virus would be contained and that grave worries about a pandemic weren’t justified.  

    By late February, Senator Burr had dumped stock worth between $628,000 and $1.7 million.. Intelligence Committee Members Feinstein, Loeffler, Purdue, Inhofe, and Johnson also unloaded a considerable amount of stock.[2]  The public was not immediately aware of these financial transactions.  The contents of the briefing have never been disclosed to the public. In a search of the Senate Intelligence Committee website, no evidence could be found that a meeting regarding COVID 19 was held.[3]

    Journalists uncovered an audio recording of Senator Richard Burr, Republican chair of the Senate Intelligence Committee, telling some donors in a private meeting that the coming pandemic could be as serious as the global flu pandemic of 1918. He was not at all as laid back and buoyant as he was in public at that time. The donor meeting occurred on February 27th.[4] 

     At the time Senator Burr was not expressing the same alarm in public he imparted to his close political allies, the President of the United States declared at a South Carolina rally on February 28th – one day after Burr’s ominous statements caught on audio – that the corona virus was a Democratic Party hoax.

    Throughout February and most of the month of March, Trump and his powerful propaganda machine consisting of Fox News, an assortment of well-funded and well-organized Christian nationalist organizations, and most of the Republican Party repeated the corona virus hoax lie. A phalanx of right-wing virus deniers, conspiracy theorists, and Fox bloviators were egged on by the president who at best was recognizing that the disease did exist, but claimed that it was primarily China’s problem and wouldn’t amount to much in the U.S.

Minimizing by the CDC, NIH, HHS, and the FDA at Senate Health, Education, Labor, & Pensions Committee Hearing

    On March 3rd, Trump Administration officials responsible for pandemic preparedness, presented their views on potential threats to public health from the COVID19 outbreak at an open hearing held by the Senate Health, Education, Labor, & Pensions Committee. Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response, HHS stated that, “The potential global public health threat posed by this virus is high, but right now, the immediate risk to most Americans is low. The greater risk is for people who have recently traveled to an affected country or been exposed to someone with COVID19.”

    After the SARS epidemic, Asian countries developed pandemic guidelines for nursing homes. The nursing home industry and HHS/CMS were totally indifferent to the steps taken by countries affected by SARS to prepare for the eventuality of another plague.[5]

Will Our Government Fail Us the Next Time?

    Over a million Americans died during the raging Covid19 pandemic. Nursing homes have been disproportionally affected. Over four years after the outbreak, two major nursing home commissions have avoided direct confrontation with the industry and CMS over lack of preparation prior to COVID and misfeasance and nonfeasance during the Pandemic. Little to no attention has been devoted to the issue of responsibility. As has become a normal response to serious negligence and consequent damage to the public by industry and government inaction, no entities or persons have been held accountable.

    The behavior of U.S. Senators privy to information not available to the public and acting on that information in their interests and to the detriment of the public is disgusting. It is in fact criminal. A flurry of activity by the DOJ, SEC, and Senate Ethics Committee was initiated and then dropped.  No one was held accountable. The government failed the American people, Senators behaved criminally, responsible parties escaped accountability, and the country moved on.

    It is delusional to believe that another scourge is not likely.  Advocates need to begin asking questions about protocols in nursing homes, stockpiling of personal protective equipment, and responsibility of the industry for preparation and administration of facilities during a pandemic.  We are dealing with an industry in which shareholders have intrinsic value and patients have instrumental value. Investors’ mission is to maximize cash flow.  To do that, they will naturally minimize care.  That is immoral and medically unethical.

[1] Over 200,000 Residents and Staff in Long-Term Care Facilities Have Died From COVID-19 | KFF

[2] The Senator Who Dumped His Stocks Before the Coronavirus Crash Has Asked Ethics Officials for a “Complete Review” — ProPublica.  Senator Feinstein sold stock worth $7 million dollars.

[3] https://www.intelligence.senate.gov/, “HEARINGS” tab.  I checked this URL in the Spring of 2020 and could not find any information about the hearing.

[4] The audio of the Senator warning his wealthy supporters about the coming plague can be heard at https://media.crooksandliars.com/2020/03/44593.mp3_standard.mp3. 

[5] (2) Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect (researchgate.net); see also: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00062-4/fulltext

House Subcommittee on the Coronavirus Ignores Nursing Home Deaths. That is a Human Rights Violation.

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By:

Dave Kingsley

U.S. House Committee Eliminates 141,000 Patient and 2,177 employee Nursing Home Deaths From Reality: Nothing to See There.

According to the Center for Medicare & Medicaid Services (CMS), 141,084 nursing home patients and 2,177 employees have died from the Coronavirus pandemic (https://data.cms.gov/covid-19-nursing-home-data). The House Select Committee on the Coronavirus under the leadership of Congressman James Clyburn – one of the three most powerful Democrats in the House – addressed 249 deaths in meatpacking plants but totally ignored nursing homes.

I have carefully read the Subcommittee’s recently released report More Effective, More Efficient, More Equitable and can find absolutely nothing about the biggest loss of life in an institutionalized population in the history of the United States (see: https://coronavirus.house.gov/news/press-releases/select-subcommittee-s-year-end-staff-report-highlights-oversight-work-releases). Adobe Acrobat PDFs have a search function. Having utilized that function on the report, I can say with certainty that words such as nursing homes, long-term care, skilled nursing, nursing home industry, or any other word that would suggest that elderly and people with disabilities institutionalized in these facilities were of any concern whatsoever to the subcommittee.

How can 141,000 patient and 2,177 employee deaths in one institutionalized population – which constitutes about one percent of the U.S. population in any one year but nearly 20 percent of the COVID-19 deaths since the pandemic appeared in 2020 – be erased from reality? Whose interests are being served by these types of hearings in Congress? Indeed, there has, in fact, been no real serious investigation by the U.S. Congress or any state legislature into the nursing home coronavirus tragedy (at least none that I have found).

The Nursing Home COVID Tragedy Was Avoidable. Therefore, It Is an Atrocity and a Human Rights Violation.

Elderly and disabled Americans were allowed to die because an industry failed to spend the money necessary to save them. The U.S. government has turned over the care of frail and disabled people to an industry well paid to care for them. It is well known and scientifically proven that the industry charged with responsibility for patients in nursing homes has consistently placed shareholder value above medical care. That fact has been demonstrated repeatedly and consistently for the past 70 years that federal and states funds have supported a privatized long-term care and skilled nursing system.

Here are the facts:

Epidemiologists and other scientists renowned in the field of emerging diseases have warned for decades that pandemics like we have experienced in the 2000s would become worse (e.g. See Laurie Garrett, The Coming Plague).

SARS taught the world a lesson about pandemics and the vulnerability of nursing home patients. Hong Kong and other Asian countries took steps to counter future pandemics. The Hong Kong Guidelines were well known throughout the world and yet the U.S. nursing home industry and government regulatory agencies ignored those guidelines while the industry created sophisticated legal and financial structures to drain ever more tax and reimbursement dollars out of the system for the benefit of executives and shareholders (See: https://www.cmaj.ca/content/192/19/ES11; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899229; https://www.ncbi.nlm.gov/pmc/articles/PMC723424/; https://www.theguardian.com/world/2020/may/19/mps-hear-why-hong-kong-had-no-covid-19-care-home-deaths.)

Political contributions suggest that the nursing home industry has tremendous sway over congressional and agency oversight. For instance, of the top 100 2019-2020 contributions to Congressman Clyburn – which total over $1 million dollars – approximately half came from corporations and lobbying groups with a vested interest in nursing home finance.

The American Health Care Association – the nursing home corporation lobbying organization – contributed $10,000 to Congressman Clyburn in the 2019-2020 cycle, but it is important to recognize that the nursing home industry is primarily a finance-insurance-real estate as well as a medical industrial complex with interlocking interests between real estate, finance, and medical sectors of the economy. Therefore, consider the following donations to Chairman Clyburn in 2019-2020:

American Healthcare Association (nursing home corporation Lobby): $10,000

National Association of REITs: $10,000

National Bankers Association: $10,000

American Hospital Association: $10,000

National Association of Realtors: $10,000

Johnson & Johnson: $10,000

KMPG: $10,000

Investment Corporation Institute: $10,000

USAA: $10,000

CVS Health: $10,000

Capital Financial: $10,000

Deloitte: $10,000

Abbot Lab: $10,000

Eli Lilly: $10,000

Bank of America: $10,000

Pfizer: $10,000

Pensare Acquisition Group: $10,000

Prudential: $19,000

AFLAC: $34,925

Government & Industry Abuse of An Institutionalized Population is A Human Rights Violation Causing A Massive Number of Fatalities. Government Officials Must Be Held Accountable. But there is No Organized Political Movement to Force that to Happen.

The U.S. government has a long history of looking the other way while widespread abuse and neglect continues pervasively throughout a privatized nursing home system funded with taxpayers’ hard earned dollars. Furthermore, over that 70-year history, an aging enterprise has been spawned by the Older Americans Act and do-gooder contributions to 501C3 organizations. We have Area Agencies on Aging, all sorts of aging-related professional organizations, gerontology professional groups, advocacy groups, the AARP, and countless other special interest organizations have settled into a comfortable relationship with government agencies responsible for regulating nursing homes and the industry itself, which has a high powered PR machine. An ongoing game of rope-a-dope between the industry and advocates over minor tweaks to a system that should be ended not mended takes place ad nauseum, ad infinitum in legislatures across the land.

Nursing home neglect and abuse continues on a regular basis while shareholders and executives get fabulously rich from Medicaid and Medicare funded commercial real estate. It appears, however, that a coalition of so-called senior advocacy organizations cannot mobilize to force congress to take a hard look at the COVID-19 nursing home tragedy that didn’t have to happen.

The U.S. Nursing Home System Incurred Massive Fatalities Due to System Failure. Will We Forget it Happened?

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What Does the Death of 132,000 Institutionalized Patients Mean for the Past and the Future?

Officially 132,000 patients in the care of government funded and regulated skilled nursing facilities succumbed to the COVID-19 virus. The question with which we must now grapple is this: “Why did an unprecedented mass fatality occur to a specific institutionalized group of Americans?” Prior to COVID, the largest pandemic related sweep of death through an institution occurred in the military during WWI. Of the approximately 60,000 U.S. military deaths during the first World War, 40,000 were due to influenza.

Infectious disease experts warned us for decades that periodic pandemics would become the norm. In regard to COVID and the pandemics that preceded it, here is what Dr. Michael Osterholm and Mark Olshaker said in the preface to their new edition of Deadliest Enemy:

They all came as a surprise, and they shouldn’t have. Nor should the next one; and rest assured, there will be a next one and one after that, and on and on. And as we have outlined in this book, one of them will be even bigger and one or more orders of magnitude and more serious than COVID-19. Most likely, as we’ve written, it will be a novel influenza virus with the same devastating impact as the 1918-19 Great Influenza pandemic that killed between fifty and one hundred million people, but playing out in a world with three times the population, international commercial air travel, tinderbox. Third World megacities, encroachment of natural habitats that have brought animal reservoirs of disease to our doorsteps, hundreds of millions of humans and host animals living cheek by jowl, and a planet-wide just-in-time supply chain delivering everything from electronics and auto parts to lifesaving medicines without which the most advanced hospitals cease to function.

Michael Osterholm & Mark Olshaker, Deadliest Enemy, New York: Little, Brown, Spark

What Does One of the Few Few Experts on Presidents & Pandemics have to Say?

Max Skidmore, an expert on U.S. presidents, as well as my colleague and fellow author on this blog has written a book entitled Presidents, Pandemics, and Politics. Like so many other experts who tried to tell us what was likely to happen, Professor Skidmore presciently wrote this in 2016:

Presidents and Pandemics will argue that we must learn from past experience – mistakes and successes – in preparation for the future, and that future preparation vital to the maintenance of civilization, here and elsewhere. As critical as terrorism is in the modern world, including bioterrorism, an even greater threat comes from natural causes. It will be necessary to overcome the tendency to respond only to the most dramatic danger – the obscenities, say, of a scowling enemy decapitating a helpless captive, attacking innocent school children, or snarling evil intent that might take place here – as opposed to preparation also for what assuredly will take place here: ever more virulent pandemics.

Max J. Skidmore, Presidents, Pandemics, and Politics, New York: Palgrave Macmillan.

The U.S. Nursing Home System Was Warned and Didn’t Pay Heed to the Warning: That is Inexcusable

There appears to have been no preparation – no set of guidelines in place and enforced – to deter the rate of COVID-19 fatalities that occurred in U.S. skilled nursing facilities. If providers and agencies charged with regulating them didn’t know about guidelines for preventing mass fatalities due to a pandemic, they should have known.

Officials in Hong Kong knew about the devastation wrought by the 2003 SARS outbreak and took steps to prevent it from happening again. They issued a set of guidelines which required the following: (1) All facilities have an infection control officer, (2) Conduct annual outbreak drills, (3) Have a permanent 1- to 3-month stockpile of personal protective equipment (PPE) use, and (4) Establish visitation rules that address hygiene and PPE use, and procure technology to facilitate communication with families in case of an outbreak. Provisions were also made to externally quarantine infected residents and staff. (See: George A. Heckman, MD, et al., “Proceedings From an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes From Long-Term Care,” JAMDA, 28 April 2021, p. 2)

Seven Hundred and Sixty skilled nursing facilities in which 76,673 patients are ensconced are located in Hong Kong. It appears that approximately 30 patients in these facilities died because of COVID-19. In the U.S., it was not uncommon for a single facility to have 30 fatalities (e.g. Riverbend Rehab and Care in Kansas City Kansas owned by the Ensign Group, which had a phenomenally good year financially during 2020). Companies such as Life Care Centers of America, the Evangelical Lutheran Good Samaritan chain, and the Ensign Group had multiple facilities with 30 or more deaths. Fifty patients were killed in the Life Care Care Centers facility in Farmington, New Mexico, but there were many others in which excessive deaths occurred.

If There is No Accountability, the Next Natural Disaster in the Form of a Virus Will Result in Mass Fatalities of Institutionalized Skilled Nursing Patients

These days we are not hearing a call for a commission or even a strong move on capitol hill for serious investigative hearings. That is horrifying. The nursing home industry was well rewarded financially, but failed to discharge its responsibilities to care adequately for patients. My colleague Professor Charlene Harrington and I have conducted in depth research into the financial performance of publicly listed corporations deriving their revenue from public funds. They did quite well during 2020 and have as of yet not been called before congress to answer for their performance during 2020. We will continue to conduct that research and disseminate the results. (see: (See: Kingsley DE, Harrington C. “COVID-19 “Impact on publicly traded nursing home companies,” J Am Geriatr Soc. 2021; 1-4. https//doi.org/10.1111/jgs.17288.

Dave Kingsley

CMS REPORT PRODUCED BY ITS NURSING HOME “INDEPENDENT CORONAVIRUS COMMISSION” IS HORRIFYINGLY DEHUMANIZING AND PROPAGANDISTIC

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    By Dave Kingsley

The Center for Medicaid and Medicare Services released the report from its “independent”[1] “Coronavirus Commission for Safety and Quality in Nursing Homes”[2] yesterday (September 17th). The CMS press release announcing availability of the report[3] was a cynical, venal, propagandistic use of the commission’s work as cover for dereliction.

    Federal and state agencies charged with overseeing the nursing home system and the industry to which the care of our frail elders and disabled have been entrusted failed in their responsibilities.  The commission report is their exoneration.  In essence, the lives of our elderly and disabled brothers and sisters have been devalued and their future health and well-being placed in jeopardy.

    The title to the CMS press release was worded as follows: “Independent Nursing Home COVID-19 Commission Findings Validate Unprecedented Federal Response.”  The Trump Administration gave itself a pat on the back with unbelievable lies in its description of the contents of the report, which very few people will take the time to read.  For instance, Seema Verma was quoted as saying, “The Trump Administration’s effort to protect the uniquely vulnerable residents of nursing homes from COVID-19 is nothing short of unprecedented.”

    Does this sound like Donald Trump, who claims that he created the greatest economy in history and never tires of claiming that he has done more than any other president in practically every policy area?  By now everyone should understand that the current president is a cruel psychopathic narcissist and a pathological liar with no empathy?  Seema Verma is a quintessential toady who remains in her position by adhering to a dangerous autocrat’s demand for fealty.

    Verma made the obligatory “dear leader” praise of Trump by saying “President Trump sought to refine our approach still further as we continue to battle the virus in the months to come.”  How, I might ask, did he do that?  She went on to say this about the commission:  “Its findings represent both an invaluable action plan for the future and a resounding vindication of our overall approach to date.”  

    In fact, the report is page after page of technocratic proposals and pretentious jargon.  On their face, these proposals are innocuous.  My questions about this classic piece of “inside the beltway wankery” are:  “Why weren’t these things being done prior to the pandemic, or at least being done in January when the administration was warning the Senate Intelligence Committee about a coming pandemic that could rival the 1918 Flu?”

    In the days ahead, I’ll be blogging about the contents of the so-called independent commission report.  I want to encourage a conversation among advocates, scholars, and activists about the following issues:

  • The role of the nursing home industry (including the nonprofits) in the COVID-19 nursing home tragedy, which was excised from the commission’s report and perhaps altogether from its work.

  • The economic/financial context of the nursing home industry in 2020.  The evolution of capitalism to financialization and management theory to transaction and agency has had a major impact on the mission of real estate and other industries in the long-term care business.

  • The disturbing movement among major bioethicists to devalue the lives of elderly Americans and advocate for medical care rationing due to a misguided and erroneous belief that the 65+ population is a threat to the U.S. economic system. 

[1] It is important to note that the word “independent” was not in the official title for the commission, but CMS placed the adjective before the “Corona Virus Commission for Safety and Quality in Nursing Homes” in a press release for the purpose of capturing the cachet of members and the imprimatur of their organizations as a propaganda ploy.

[2] https://edit.cms.gov/files/document/covid-independent-nursing-home-covid-19-federal-response.pdf; see the full report here: https://edit.cms.gov/files/document/covid-final-nh-commission-report.pdf

[3] https://www.cms.gov/newsroom/press-releases/independent-nursing-home-covid-19-commission-findings-validate-unprecedented-federal-response