New York City Spring 2020: Emergency Department/Outpatient Deaths & Cuomo's Nursing Home Policy, Part 1.5

More things that don't make sense

Note: This post draws content from Twitter threads I wrote today and yesterday. The Nursing Home section is a follow up to a “Part 1” I wrote in May.

Comments welcome here or on Twitter.

Emergency Department/Outpatient Deaths: Did a Bomb Go Off?

Reminder: New York City Emergency Department visits did not show signs of a spreading deadly pathogen before or when "15 Days to Slow the Spread" was declared.

So how did normal - and then way below normal - ED visits produce a sudden explosion in Emergency Department/Outpatient deaths?

Did a bomb go off and I missed it? Or was the federal declaration impeccably timed and deaths would have been worse without it?

Incredibly, by early May, the excess death in EDs/outpatient is gone…and doesn't return for the rest of the year! That’s a pretty absurd claim for a city of 8 million people that saw civil unrest and ongoing mitigations.

Equally absurd is what we see from disaggregating ED/outpatient deaths attributed to COVID-19 from deaths NOT attributed to COVID-19.

Behold, a very short 6 week event, with the majority of deaths excess blamed on a Newly-Named disease (COVID-19) — which was effectively "defeated" in these settings by the second week of May.¹

Nothing about the magnitude or timeline of the appearance of disappearance of those deaths screams “Spreading-disease outbreak!”

It’s more like “Earthquake!” “Massive storm!” or “Aerial assault!”

And it demands an explanation that doesn’t insult Americans’ intelligence.

NOT Nursing Homes - HOSPITALS

I’ve said this many times on Twitter, Substack, and in presentations/interviews, but I'm going to say it AGAIN:

Most NYC resident deaths in spring 2020 were in HOSPITALS.

NOT nursing homes — HOSPITALS.

Was there an incredible number of deaths in nursing homes and personal residences - and a curiously low number in hospice facilities?

YES.

However, to this day, it's the HOSPITAL data that has avoided scrutiny - perhaps in part because of the focus on nursing homes.

But where did most deaths that listed COVID-19 as underlying cause occur?

HOSPITALS.

Per federal data, 83% of all COVID-19 deaths in the five boroughs were in hospital inpatient/EDs/outpatient. A far lower share, 9%, occurred in nursing homes.²

Make no mistake: I am not minimizing the nursing home toll. A 277% increase in the facilities is horrifying, as was the mistreatment, neglect, and isolation.

Rather, I am continuing to poke holes in the claim that New York City’s mass casualty event is largely due to then-Governor Andrew Cuomo's so-called "nursing home policy."³

The timing of that advisory is curious. It was issued on March 25th — the same day the CARES Act was passed — and two days after another Cuomo order told hospitals to expand bed capacity by 50%.

The truth is, “COVID positive” patients were ALREADY in nursing homes. That is, they were being sent to hospitals before the Nursing Home policy was issued, in accordance with federal guidance issued earlier.

The Newly-Named Virus didn't "arrive" in nursing homes with the policy any more than it first “arrived” in New York City hospitals when the first positive test in a hospitalized patient was announced on March 2nd.

The claim about COVID+ patients going into nursing homes from hospitals and "spreading" the pathogen is also challenged by the 20% decline in discharges from city hospitals to skilled nursing facilities in 2020. These data aren’t available to the public in a daily, weekly, or monthly format, which makes it impossible to discern when these discharges began declining or compare/overlay those with other kinds of time-series data.

For example, the city ambulance data that alarming decreases in dispatches transporting patients during these weeks.⁴ [12/5/23 UPDATE: The original version of the graph posted showed “spikes” in the dataset that we later found were a result of a statistical program (SAS) reversing dates. We resolved the issue and have posted the the corrected graph.]

And we still don’t know how many New York City nursing home residents total died in one of the deadliest mass casualty events the city has ever experienced. The state continues to withhold time-series data that would show how many of those residents died in hospitals, versus in care facilities, regardless of cause.

In November 2022, Governor Kathy Hochul commissioned a $4.3 million “pandemic review” by Olson Group Ltd., a Virginia-based emergency management consulting firm.

An update and preliminary report to the Government and state department of Homeland Security was anticipated after the first six months of the firm’s work.⁵

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Access all of my posts related to New York City’s spring 2020 mass casualty event here:

New York City Spring 2020 Inquiry

1. Notably, deaths in EDs/Outpatient decreased and dropped to baseline before deaths in Hospital inpatient, nursing homes, and personal homes.

2. I’ll devote a future post on the insanity of NYC deaths at home during these weeks. “COVID-19 deaths at home” is a questionable claim altogether - even beyond the general problem of the WHO’s ICD code and guidelines for COVID deaths. Note that NYC’s COVID-19 deaths at home comprised 40% of all deaths so-classified in the U.S. in April 2020 were in New York City. Again, did a bomb go off that nobody knows about?

3. This was March 25, 2020 advisory that said the facilities couldn’t reject a resident for admission or readmission on the basis of whether or not the person was positive for SARS-CoV-2. March 25 was the same day Congress passed the CARES Act, which effectively “compensated” hospitals for disruptions to regular operations that came with the federal emergency declaration by adding more money to certain reimbursements that involved a patient diagnosed with COVID-19.

4. I’m still unable to independently verify the “mechanics” of the claim that thousands of patients left New York City hospitals alive and went back to nursing homes where they “spread COVID.” Toward that goal, I submitted the following request to Fire Department of New York [City] (FDNY) on March 2, 2023:  Records showing the 1) Daily number of ambulance pick-ups from NYC nursing homes/long-term care or other congregate living facilities to NYC hospitals, between 1/1/2020 and 5/31/2020, 2) Daily number of ambulance pick-ups from NYC hotels to NYC hospitals, between 1/1/2020 and 5/31/2020, 3) Daily number of ambulance picks-up from NYC police stations to NYC hospitals, between 1/1/2020 and 5/31/2020, 4) Daily number of ambulance picks-up from NYC jails & prisons to NYC hospitals, between 1/1/2020 and 5/31/2020  My last communication with FDNY said I can expect a response ~Nov 28, 2023.

5. As far as I know, a preliminary report hasn’t been made public. Readers can correct me if I missed it.