Did bad advice kill a thousand people in Irish nursing homes?

A fascinating clip from the United States, over the weekend, which should raise real questions about the management of Covid in Irish nursing homes:

https://twitter.com/ZacBissonnette/status/1360982497769775104

In Florida, says that state’s Republican Governor (and, by the by, future Presidential candidate), Ron DeSantis, the medical experts told him that if he kept patients from nursing homes in the hospital, they would run out of beds.

The advice from those medical experts, he says, was to send patients with Covid back to the nursing homes, or keep them there in the first place, because otherwise there might not be enough beds in Florida hospitals for younger, healthier people, with Covid.

Does that sound familiar? It should.

Florida didn’t take the advice, says DeSantis, because he’d have preferred to build large temporary field hospitals rather than send sick people back to nursing homes, where they could infect others.

In New York, by contrast, they took the advice. And in Ireland, while we don’t know for certain what the advice was, we do know for certain that sick patients with Covid were left in nursing homes and not admitted to hospital. How likely is it that the advice was substantially different?

The problem, of course, is that the advice was wrong.

The estimates of Covid deaths and Covid hospitalisations have been consistently, and repeatedly, far too pessimistic. You may not remember it, now, but in the very early days of the pandemic, last year, there were real fears that the hospital system would be overwhelmed.

In the end, almost 1,000 people died in Irish nursing homes, comprising an overwhelming majority of the deaths in the first wave of Covid 19 in Ireland.

The question must be asked, therefore: Was the massive epidemic in Irish nursing homes last year the result of a deliberate, and mistaken, policy choice?

It’s important here to say what the word “deliberate” means: Nobody is arguing that the Irish Government set out to cause an epidemic in nursing homes. By “deliberate policy” we don’t mean that the policy was to kill off elderly people in their care homes. What’s meant is that the policy was to maintain space in the hospitals by triaging older, more at risk, patients, to keep beds open for those with a better chance of survival. That’s not necessarily a bad, or wrong, policy, if you’re faced with a choice between saving the younger and fitter, or saving the older, and more likely to die.

That’s the choice the Government may have thought it was facing.

The problem is, of course, that it wasn’t how things ended up.

Which begs the question: Where did the faulty advice come from, and are the people who provided it still providing advice today?

In a proper, functioning democracy, these are questions that should be asked and debated openly. When the Covid crisis passes, there will be a tremendous outbreak of back-slapping and self-congratulation from Ireland’s political class, who will shamelessly claim the credit for steering the country through the storm. There won’t be much political appetite, at least not on the part of the Government, to investigate or highlight any major failures.

Indeed, there isn’t much appetite for it in the media, either.

The problem is, however, that almost a thousand older people died. Some of them, of course, would have died anyway. Others would still be alive today, if they’d been in a hospital. Others would be alive today if the person with Covid in the next bed had been in a hospital.

Florida took a very different path in dealing with Covid than Ireland did. That is not to say that it took a better path, necessarily: They’ve had 21,000 deaths, Ireland has had almost 4,000. Adjusted for population, Ireland, if it had as many people as Florida, would have had about 17,500 deaths. So in terms of saving lives overall, Ireland has done better.

But Florida’s approach didn’t focus nearly so much on virus suppression: They’ve had much less strict lockdowns, for example, and, as a result, far more people sick overall than Ireland did.

That doesn’t take away, though, from the specific question about nursing homes: Ireland seems to have abandoned the sick and the dying in the nursing homes, to save the hospitals.

There’s a very strong case to be made that this was one of the worst decisions made in the history of the country.

 

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