More Nuanced Approach Needed To Fight COVID-19

By John McManus, president and founder, The McManus Group

Editor’s note: This article was written May 20, 2020, so some statistics may be outdated by publication date.

As the data on COVID infections and deaths are tabulated, it has become clear that a more nuanced and targeted approach is needed to protect the vulnerable and allow the rest of the country to reopen and get back to work, school, and the day-to-day activities that make life enjoyable. Protecting the elderly, particularly those in nursing homes, should be the paramount public health priority, but continued and indefinite shutdowns of schools, camps, and activities of the young are not relevant to protecting the public.

More than one-third of COVID-related deaths have occurred in nursing homes (and 40 percent if assisted living facilities are included), though nursing home residents comprise just 0.4 percent of the nation’s population — 1.4 million of the 328 million Americans. Notwithstanding, for reasons unclear to most, New York and Pennsylvania ordered recovering COVID patients leaving hospitals to convalesce in nursing homes. Those decisions were a death sentence to many of the 30,000 people who died in nursing homes due to COVID. The nursing home population is mostly elderly, often suffer numerous comorbidities, and live in tight quarters where viruses can be easily transmitted. A Government Accountability Office report found that about 40 percent of the nursing homes inspected in each of the past two years were cited for problems with infection control and prevention.

COVID deaths skew heavily to the very old and are minimal in the young. National CDC data through May 9 show that 32 percent of deaths are over age 85, 59 percent are over age 75, and 18 percent are below age 65. State statistics are even more striking:

• Pennsylvania is one of the hardest hit states with 4,453 deaths and has more COVID deaths over age 100 than under 45; more over age 90 than under age 60; and more over age 85 than age 80.
• Illinois’ deaths over age 80 (1,960) are three times as many as under 60 (605).
• California had zero deaths under age 17 and 79 percent over age 65.
• Michigan had more than eight times as many  COVID deaths over age 80 as under age 40.

Florida was widely criticized for allowing citizens to use the beaches, but it appears vindicated for focusing its regulatory powers on protecting the vulnerable. Gov. Ron DeSantis issued an executive order on March 15 to ban visitation in nursing homes and ban the reintroduction of a COVID positive patient into a nursing home. Florida has roughly the same population as New York but 7 percent the number of COVID deaths.

Nonetheless, for much of the country, the universal shutdown continues with closed schools, shuttered businesses, and others struggling to hold on as days have stretched into weeks and then into months, with no definitive end in sight. Talk of cancelling school next fall has parents wondering if their kids will ever get a real education, including the essential social interactions and competitive sports that help kids develop and navigate relationships that are critical to becoming productive adults. Sweden never closed its schools but has one of the lowest infection rates in the industrialized world and exactly one pediatric death from COVID.

Many small businesses that require face-to-face interaction with their customers wonder when they can reopen or whether they can generate sufficient volume when their businesses reopen under intrusive restrictions. Restaurants may see their seating capacity cut by more than 50 percent, and productivity of healthcare facilities may suffer commensurate inefficiencies as time between procedures is increased to limit patient interactions and extra steps are taken to sterilize operating rooms between procedures. How does this impact businesses that had razor-thin margins before the pandemic?

Government bureaucrats and academics with secure jobs arbitrarily decide which private businesses are essential. Cannabis dispensaries (for medicinal purposes only, you know) are deemed essential but barbers are not. It took 50 years, but the hippies have finally won: Buying marijuana is legal but getting a haircut is not!

WEIGHING TRADE-OFFS VS. APPLYING ONE POLICY METRIC

We were told that a shutdown was needed to “flatten the curve” and slow the spread of the disease so that hospitals would not be overwhelmed with cases. Hospitals now have the lowest occupancy rate in history because elective procedures have plummeted so precipitously.

Yet some politicians now argue that the lockdown must continue until a vaccine is available. That may not be months away but actually a year or more. Moderna’s news that its Phase 1 trial looked promising, which sent the stock market surging, concerned a grand total of eight patients!

Avik Roy, president of the Foundation for Research on Equal Opportunity, commented, “It is clear from these analyses that death from COVID is low for those under 55, and especially under 25. By contrast, it is relatively high for those over 75. The evidence should lead us to consider ways to reopen schools and postsecondary institutions like colleges. It should also lead us to do everything we can to protect the elderly, especially those in nursing homes.”

I could not agree more, but Washington seems oblivious to this common-sense approach. Instead, it’s throwing even more money at symptoms of the economic collapse the shutdown has produced, rather than focusing on ways to safely reopen the country while protecting the vulnerable. A couple weeks ago, the House of Representatives narrowly passed its fourth COVID relief package costing a grand total of $3 trillion. To put that in perspective, that’s equivalent to cutting each citizen a check of almost $10,000.

The Republican-controlled Senate has made it clear that the bill is dead on arrival. But as unemployment heads toward 20 percent and resources provided in previous stimulus packages are depleted, pressure will build for further congressional action.

The federal government has resources to provide temporary Band-Aids — why stop now when we only have $24 trillion of debt? But it will be the state and local governments that control when, how, and under what circumstances its citizens can resume their lives, which is much more fundamental. Those decisions cannot be left solely to public health officials whose only metric of success is deterring even one more COVID death.

Americans elect leaders to make decisions on policy options that are inherently political and require the weighing of trade-offs of those decisions. Hopefully, these decisions are guided by the mounting data that suggests targeted approaches to containing the pandemic would be beneficial for both the vulnerable and the rest of the population, which must get on with living their lives and providing for their families.

John McManus is president and founder of The McManus Group, a consulting firm specializing in strategic policy and political counsel and advocacy for healthcare clients with issues before Congress and the administration. Prior to founding his firm, McManus served Chairman Bill Thomas as the staff director of the Ways and Means Health Subcommittee, where he led the policy development, negotiations, and drafting of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Before working for Chairman Thomas, McManus worked for Eli Lilly & Company as a senior associate and for the Maryland House of Delegates as a research analyst. He earned his Master of Public Policy from Duke University and Bachelor of Arts from Washington and Lee University.