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June 5, 2020

The Importance of Long-term Care Populations in Models of COVID-19

Author Affiliations
  • 1Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, Department of Human Development, Cornell University, New York, New York
  • 2Courant Institute of Mathematical Sciences, New York University, New York, New York
  • 3Cornell Institute for Disease and Disaster Preparedness, Departments of Medicine and Population Health Sciences, Weill Cornell Medicine, New York, New York
JAMA. 2020;324(1):25-26. doi:10.1001/jama.2020.9540

In February 2020, the US outbreak of novel coronavirus disease 2019 (COVID-19) began with a cluster of cases at a long-term care (LTC) facility in Washington State. Since then, 34 of the 40 states with available data report that at least 40% of COVID-19-related deaths in those states have occurred in LTC facilities,1 which provide ideal conditions for rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the populations in these facilities bear a significant burden of the pandemic, mathematical models that contribute to US national or state policy do not account for residents of LTC facilities separately from surrounding populations in their calculations.2 This Viewpoint explores why it is important to separate projections for residents of LTC facilities and the general population.

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    1 Comment for this article
    The Balance Between Fine-Grained Policy and Discrimination
    Robert Wang, Ph.D., M.D. | Private Practice
    Virus transmission and lethality, and related use of healthcare resources differ between SNF populations, chronically ill home dwellers, and young fully functional segments of the population. Correspondingly, the accuracy of projections will improve with more fine-grained data collection and analysis of morbidity and mortality.

    Of course, policy should represent the most effective response in minimizing the adverse effects of the pandemic.

    However, there are competing social interests which will need to be considered in actually developing such policy. For example, if New York City is an active outbreak site, the best policy might be full quarantine
    of the city with no ingress or egress, while allowing suburban travel without restriction except incidental masking. This type of embargo seems to have been employed in Wuhan. Would it be acceptable in the U.S?

    Would we allow municipalities to proscribe public movement by people with diabetes, who have a high mortality rate associated with COVID-19 infection, but not those with normal glucose tolerance?

    The balance between efficiency of compartmental analysis of data and mechanisms of disease and the social contract as we understand it - especially in these particularly fraught times - may be a difficult task.