[OutsiderFan]

Hartford County might have the highest Covid-19 death rate in the world, certainly in the U.S., with just under 6,000 confirmed cases, but over 700 deaths. I believe half these deaths have been in nursing homes and long-term care places.

My infection control nurse friend's facility - where I am in West Hartford - entered April with no cases and 120 residents. They are now down to 86 and the virus is without doubt in the building. Shockingly, it is going to start taking new patients this coming week, even though it is a known fact the virus is circulating there. The hospitals are saying they can't keep people for non-Covid stuff any longer, and it doesn't appear there is any urgency to bring anyone sick with Covid back to the hospital.

If the virus still exists in the building, sending new people there is like putting them in a "Roach Motel" because these places don't have ventilators or other sophisticated hospital capabilities. They are effectively being used as hospice services, not rehab facilities as intended. The virus is going to never stop spreading in these environments if the transmission chains are never broken.

The same goes for meat processing and prisons. Nobody has shown any way to isolate people in these places to stop virus spread. Workers who don't want to work because the don't want to get sick will be fired. New nursing home patients will come into infected buildings. New prisoners are always coming into correctional facilities.

There are 25,000 nursing home and care facilities, 2,000 prisons, and almost 3,000 meat processing plants. If the virus isn't halted in these places, we are going to have up to 30,000 virus incubators across the country, all ready to be the impetus for new outbreaks at any time. If we had used the time in lockdown to halt spread of infection in these settings, I would feel good about being able to manage what happens when they are lifted. We absolutely did not, so it seems we will be in a far worse position after restrictions are lifted than when they were put in place. I don't think that was the objective.

[OutsiderFan]

Hartford County might have the highest Covid-19 death rate in the world, certainly in the U.S., with just under 6,000 confirmed cases, but over 700 deaths. I believe half these deaths have been in nursing homes and long-term care places.

My infection control nurse friend's facility - where I am in West Hartford - entered April with no cases and 120 residents. They are now down to 86 and the virus is without doubt in the building. Shockingly, it is going to start taking new patients this coming week, even though it is a known fact the virus is circulating there. The hospitals are saying they can't keep people for non-Covid stuff any longer, and it doesn't appear there is any urgency to bring anyone sick with Covid back to the hospital.

If the virus still exists in the building, sending new people there is like putting them in a "Roach Motel" because these places don't have ventilators or other sophisticated hospital capabilities. They are effectively being used as hospice services, not rehab facilities as intended. The virus is going to never stop spreading in these environments if the transmission chains are never broken.

The same goes for meat processing and prisons. Nobody has shown any way to isolate people in these places to stop virus spread. Workers who don't want to work because the don't want to get sick will be fired. New nursing home patients will come into infected buildings. New prisoners are always coming into correctional facilities.

There are 25,000 nursing home and care facilities, 2,000 prisons, and almost 3,000 meat processing plants. If the virus isn't halted in these places, we are going to have up to 30,000 virus incubators across the country, all ready to be the impetus for new outbreaks at any time. If we had used the time in lockdown to halt spread of infection in these settings, I would feel good about being able to manage what happens when they are lifted. We absolutely did not, so it seems we will be in a far worse position after restrictions are lifted than when they were put in place. I don't think that was the objective.

[M T]

The same goes for meat processing and prisons. Nobody has shown any way to isolate people in these places to stop virus spread. Workers who don't want to work because the don't want to get sick will be fired. New nursing home patients will come into infected buildings. New prisoners are always coming into correctional facilities.

Regarding prisons.  Check out the cases in the Ohio prisons versus housing type.  There are 2 highly impacted and mostly minimally impacted institutions.  As of 5/1, there are 19 (0.2%) cases in 10 "cell" facilities where 9,853 are quarantined (I didn't compare the full population to these numbers) and
there are 3747 (13.8%) cases in 15 "combo" facilities where  27,101 are quarantined.  Of those combo facilities, only 2 institutions are above the average (nearing 100% infections).   Perhaps this isn't sufficient to say that some prison types may be more resistant to widespread infections, but it suggests that possibility.

I'd also think that turnover rate, visitation policies (talk on phone behind a plexiglass window vs in-person) and any short-term release policies (to attend funeral or birth, for instance) can impact the introduction of the virus.   A prison could institute a 2-week isolation period upon incarceration and a 2-week isolation prior to scheduled release, to protect both the prison population and the general population.   I suspect you can effectively isolate the prison population from outside influence EXCEPT for guards or other staff (medical).

I'd be concerned more about jails (drunk tanks, etc.) with a high turnover of individuals as a mechanism of spread.  I expect that SiP has resulted in far fewer people going into such jails.

Other congregate housing includes military and homeless.  I would include school dorms and summer camps as congregate housing that will facilitate rapid spread.

IMO, having summer camps this summer is dangerous.  Where is a 2 week isolation going into or coming out of these camps?  Is this any different than a miniature spring break scenario?  Bring together people from diverse locations any of which likely has some virus, give them enough time to spread any infection, but not so long that they show up with symptoms, and then spread them out to the four winds, often without any easy way for the individuals to track each other.  ("Johnny, who was at your summer camp?"  "A couple of kids, Aaron and Bill, and some others I didn't really get to know.  Cough, cough")

[M T]

The same goes for meat processing and prisons. Nobody has shown any way to isolate people in these places to stop virus spread. Workers who don't want to work because the don't want to get sick will be fired. New nursing home patients will come into infected buildings. New prisoners are always coming into correctional facilities.

Regarding prisons.  Check out the cases in the Ohio prisons versus housing type.  There are 2 highly impacted and mostly minimally impacted institutions.  As of 5/1, there are 19 (0.2%) cases in 10 "cell" facilities where 9,853 are quarantined (I didn't compare the full population to these numbers) and
there are 3747 (13.8%) cases in 15 "combo" facilities where  27,101 are quarantined.  Of those combo facilities, only 2 institutions are above the average (nearing 100% infections).   Perhaps this isn't sufficient to say that some prison types may be more resistant to widespread infections, but it suggests that possibility.

I'd also think that turnover rate, visitation policies (talk on phone behind a plexiglass window vs in-person) and any short-term release policies (to attend funeral or birth, for instance) can impact the introduction of the virus.   A prison could institute a 2-week isolation period upon incarceration and a 2-week isolation prior to scheduled release, to protect both the prison population and the general population.   I suspect you can effectively isolate the prison population from outside influence EXCEPT for guards or other staff (medical).

I'd be concerned more about jails (drunk tanks, etc.) with a high turnover of individuals as a mechanism of spread.  I expect that SiP has resulted in far fewer people going into such jails.

Other congregate housing includes military and homeless.  I would include school dorms and summer camps as congregate housing that will facilitate rapid spread.

IMO, having summer camps this summer is dangerous.  Where is a 2 week isolation going into or coming out of these camps?  Is this any different than a miniature spring break scenario?  Bring together people from diverse locations any of which likely has some virus, give them enough time to spread any infection, but not so long that they show up with symptoms, and then spread them out to the four winds, often without any easy way for the individuals to track each other.  ("Johnny, who was at your summer camp?"  "A couple of kids, Aaron and Bill, and some others I didn't really get to know.  Cough, cough")