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Before the COVID-19 pandemic emerged, longstanding disease transmission models showed that isolating care home residents would lead to increased infections and deaths.
And yet, when COVID-19 hit governments around the world — claiming to be “following the science” — implemented policies that isolated vulnerable and elderly people in nursing homes.
That decision resulted in tens of thousands of deaths in the first few months of the pandemic in the U.S. alone.
If public health officials had applied the standard epidemiological models used before COVID-19 to inform infectious disease policy, it would have been clear in advance that their COVID-19 policies would lead to the “worst possible outcomes” for the vulnerable, according to a peer-reviewed study published Oct. 20 in PLOS ONE.
Researchers from Correlation, a Canadian nonprofit dedicated to research in the public interest, tested a standard epidemiological model used in global public health to investigate how that model predicts isolating vulnerable populations together in centralized care facilities during a pandemic would impact those populations.
This was an important question, lead author Joseph Hickey, Ph.D., told The Defender, given the “disastrous outcomes” of nursing home policies during the pandemic.
Such models — which existed in the scientific literature for decades before the World Health Organization’s COVID-19 pandemic declaration of March 11, 2020 — “unambiguously predict a significant increase in the infectious disease attack rate for the vulnerable population when it is isolated and segregated from the general population,” Hickey wrote in a press release.
“Governments used these models to justify many, many policies, like lockdowns and isolating people in care homes,” Hickey said. “But I would say they were a pretext rather than a valid justification.”
He said one might guess a model would predict that completely isolating vulnerable people in an epidemic makes sense. But when you do the calculations, “It turns out that it’s the opposite. It’s actually the worst thing that you can do.”
He added, “It’s counterintuitive in that sense, and it demonstrates that the government’s knee-jerk reaction of segregating the vulnerable was incorrect. That’s the result that we found from doing this research.”
According to the study, governments used theoretical epidemic models to make policies for COVID-19 with “tunnel vision,” focused only on reducing the risk of infection with a particular virus.
“They appear not to have considered what those same models predict about infection rates under conditions of care home segregation; and they appear to have disregarded the exponential increase of infection fatality rate with age,” the study’s authors wrote.
Instead of protecting the vulnerable, “Care home segregation policies may have been responsible for many deaths attributed to COVID-19 in Western countries,” the authors wrote.
How the study was conducted
The researchers used a general “susceptible-infectious-recovered” compartmental model — the model reportedly used as the basis for COVID-19 policies worldwide — to model health outcomes among two types of people: robust, who make up the majority of the population, and vulnerable, who make up the minority.
The model accounts for the different levels of susceptibility of the two groups. It predicts health outcomes for them based on two key parameters — how often a person comes into contact with infectious individuals and how long it takes them to recover from an illness and become immune.
These parameters are the foundation for the baseline epidemiological models on which “essentially all” more sophisticated models are built. They use these parameters to determine when an epidemic emerges and what its magnitude and duration will be, the authors wrote.
Understanding how these parameters interact and shift in a given situation is key to understanding the impacts of any non-pharmaceutical interventions introduced during an epidemic.
To measure the effects of isolating the vulnerable in a pandemic, the researchers used the susceptible-infectious-recovered model to model outcomes in the robust and vulnerable populations under different scenarios of isolation and interaction.
They found that vulnerable people have a lower risk of infection if they intermingle with the robust population than if they are isolated together in care homes, where they are exposed to more people who are infectious for longer periods of time.
Trying to isolate vulnerable people from each other in care homes doesn’t work, the authors noted, because airborne respiratory illnesses circulate via long-lived suspended viral particles and everyone ends up breathing the same air.
They also emphasized that confining people in care homes isolates them from society, loved ones and other residents. Psychosocial factors such as depression, lack of social support and loneliness have all been shown to have serious negative health effects.
The authors concluded that the existing knowledge at the time the pandemic was declared already indicated that isolation and segregation of the elderly would be of no benefit in preventing deaths in epidemic or pandemic circumstances.
The study is important, Hickey said, to inform ongoing investigations into the healthcare catastrophe that occurred in long-term care homes in Canada and other countries in the spring of 2020.
Nursing home deaths in the U.S. and Canada
The Centers for Medicare & Medicaid Services (CMS), a sub-agency of the U.S. Department of Health and Human Services, in March 2020 issued a memo directing nursing homes in the U.S. to restrict all visitors and non-essential healthcare personnel, except for certain compassionate care situations.
CMS didn’t lift those restrictions until Nov. 2021, when it still directed care homes to ask visitors to mask, social distance when “community transmission is high” and test for COVID-19.
For 18 months, people were restricted, limited or discouraged from visiting their vulnerable loved ones in nursing homes.
At the start of that period, at least five governors, including Gov. Andrew Cuomo in New York, ordered nursing homes to readmit sick elderly people who had been sent to hospitals with a COVID-19 diagnosis.
Many argued this practice led to massive numbers of nursing home residents dying at the start of the pandemic.
In the first six months after the declaration of the pandemic, 69% of deaths in Canada attributed to COVID-19 happened in care homes — a rate higher than any other wealthy country — according to a report by the Canadian Institute for Health Information.
That report found the total number of resident deaths was higher than in the years prior to the pandemic, even in places with fewer COVID-19 deaths, which it attributed to the effects of lockdown and isolation measures on care home residents.
“The proportion of residents who had no contact with a loved one tripled in the first wave, compared with previous years. Residents who had no contact with family and friends were more likely to be assessed with depression,” the report said.
The situation got so bad for elderly and vulnerable people isolated in care homes during those first six months, that in Ontario and Quebec, 1,500 members of the Canadian Armed Forces were deployed to 32 of the “most severely impacted homes,” where they found levels of neglect and abuse so severe that residents were dying from thirst and malnourishment.
But the dire outcomes in care homes during the first six months of the pandemic had no impact on national or state policies for care homes during the second wave of COVID-19 in the fall of 2020, the CBC reported.
Hickey said a better policy solution is, and was, clear:
“It’s crucial for vulnerable people in care homes to be able to maintain visitation, to be able to see their family and other visitors and staff. So that’s absolutely essential for their health. And there are lots of reasons for that, but those social connections are very, very important. And the stress of isolation and loneliness and having your world change in a dramatic way, not being with your family anymore — that stress is actually very dangerous.
“And when you’re vulnerable, when you’re already in a vulnerable state, that can actually be quite harmful to you for your health. And it can make you more susceptible to infectious diseases as well. That’s really demonstrated in the literature.
“So the way to protect them is to take good care of them and to make sure that they have good living conditions, good interaction and good care.”