The Big Lie

“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

          --Some Guy

It seems like the Internet loves a juicy conspiracy story, but can’t recognize real collusive patterns when they are right there for the viewing.

And what is the big lie of the title of this post?

That we are “all in this together” when it comes to COVID-19.

Here’s a report from Amnesty International about the UK’s treatment of old people living in care facilities with the advent of COVID-19.

This report describes how government policies and standard care practices in the UK led to excess death and suffering. Care facilities were forced to rapidly accept COVID-19 positive patients. The government also refused to push for testing in this population, and, in addition, patients were routinely denied hospitalization from care homes—despite hospitals standing virtually empty in the Spring of 2020.

And in the United States we have seen a similar situation initially in New York, where the government forced care facilities to take COVIS-19 patients, leading to high excess mortality in that population. Overall, at least half of all COVID-19 deaths in the US have come from a group that makes up less than one percent of the population—people in what are colloquially called “nursing homes.”

Meanwhile, the healthy population under 30 years of age in these countries has been subjected to social isolation, increased mental health issues, increased suicidality, reduced future income, degraded education and a great deal of non-trivial fear and inconvenience, over something that has extremely low risk of any danger to them.

Remember, there is nothing in the world that is completely without risk. You could walk outside on a bright, sunny day and be struck by lightning. It’s called clear sky lightning. It’s very, very rare to be hit by clear sky lightning, but we can’t say it's never going to happen. And every year, five or ten of the hundreds of millions of people who go swimming get an infection with a brain eating amoeba and die. Major airlines’ planes very, very, very rarely crash, but that’s not the same as never. And so on.

Yet, of course, we still swim, and get on airplanes, and even go outside on occasion. Simply put, the risk involved is so small, that it is not worth the negative consequences of stopping doing these activities when we need to.

That’s where COVID-19 restrictions and lock-downs and cancellations are with young people. It is simply not worth it.

When it comes to COVID-19 and frail people in their late 70s and up, it’s quite a different story. These people, if they contract any acute lower respiratory tract ailment, are at a high risk of dying. And the COVID-19 virus has two to three times the usual respiratory virus fatality rate in this population as well. Up to 15% of people over 80 who contract a significant COIVD-19 infection will die.

So why are we pretending everyone’s the same to the detriment of both ends of the scale?

It comes down to money.

As detailed in a previous post: ( ) Western European countries have for many years practiced both explicit and implicit geronticide. This can take the form of killing older people with lethal injections, but also more usually happens through policies such as not letting people have supplemental oxygen, or limiting hospital admissions.

Why? Because they don’t want to pay for care. With government sponsored health care, money spent on care is seen as a sunk cost, not a revenue generator. These are not vigorous, voting old people we are talking about. These are sick, probably cognitively impaired old people who don’t have any money.

In the US, situations such as that in New York state also occur due to payment issues. Hospitals pressured Governor Cuomo to demand that nursing homes accept patients because they feared they would not get reimbursed for their care if they remained in the hospital after government policies said they were no longer ill enough to stay there.

But there’s a bigger problem here. It’s still about money, of course, but it’s been going on long before COVID-19.

Whether it’s because of government budgets, or as in the US, corner-cutting private profiteering, “nursing homes” have long been run as cheaply as possible.

Why? Because we are okay with that. Whether it’s denial (“that won’t happen to me”) or ableism (“being old and demented means life isn’t worth living anyway”) the end result is that we have been fine with underfunding and profiteering at the expense of this vulnerable population.

The author of this post has worked as a nursing assistant in a nursing home, and also visited about 50 different facilities as a consulting physician. Whatever is being charged to the family, care in these places is uniformly bad.

The lurid stories that people imagine of patients being hit or abused actually rarely happen. Instead, neglect is built into the system.

The major determinant of quality of care in a health institution is the quality of nursing care. It’s not doctors, who are well compensated for briefly visiting assisted living facilities, or the number of government bureaucrats and inspectors per patient.

And nursing care is expensive. So, it’s where nursing facility corporations in the US, at least, fall down. They are not willing to pay any more than the least possible salaries, and they under staff consistently, some would say cynically. That takes its toll in attracting nursing staff.

Are you an RN with a few blots on your license; maybe some patient neglect, or stealing from a patient, or substance use problems? No worries, there’s a nursing home that will hire you somewhere. To become a “certified” nursing assistant you have to attend a few days of classes to learn the basics of taking vital signs and giving bed baths. This is an opportunity routinely offered to people with few work options in life, such as recovering substance users, felons, or those with cognitive issues that prevent them from being able to complete much education.

Now, most people who work in nursing homes are not substance users or felons. And even those with that background are usually sincerely motivated to learn new skills, help people and become productive members of society. At least at first.

But when they start their new job, they find that they are expected to care for more patients than can reasonably be handled without rushing, cutting corners, and dialing any human interaction with their patients down to a minimum. And the job itself is hard. The patients are heavy, at times verbally abusive and combative, and management in the nursing world can be harsh and fear based. All of this for about minimum wage.

There is no time to wash, or change gear between patients, especially when your job itself takes up all your energy without any extras. And in many hospitals and facilities, for nursing staff, ALL absences, even for illness, count against you—get too many, for any reason, and you’re out of a job.

Because of the lack of commitment to rational staffing numbers, and that because the most expensive thing in any business is employees, nursing facilities (ALFS, SNFs, rehabilitation units and so on) are places where infectious diseases can thrive and spread very quickly. As currently staffed, nursing facilities cannot deal with any kind of infectious threat.

Is that going to change? Will people start saying that it is worth spending the money on “the least of these?”

Or will we go back to telling ourselves comforting lies...

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