CORONAVIRUS
“Fire Through Dry Grass”: Andrew Cuomo Saw COVID-19’s Threat to Nursing Homes. Then He Risked Adding to It.
A nursing home in Troy, New York, followed the governor’s order to accept patients being treated for COVID-19. Six weeks later, 18 residents were dead of the disease.
by Joaquin Sapien and Joe Sexton
June 16, 6 a.m. EDT
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On April 3, Stephanie Gilmore, a 34-year-old nurse working at the Diamond Hill nursing home in Troy, New York, was summoned to a supervisor’s office. The home’s administrator and nursing director were there to relay some distressing news.
Gilmore said they told her that a resident in the home had recently gone to the hospital, where she tested positive for COVID-19. The resident was set to return to Diamond Hill, making her the first confirmed COVID-19 case at the 120-bed facility north of Albany.
THE RISKS TO THE HOME’S STAFF AND OTHER RESIDENTS WERE OBVIOUS: THE VIRUS WAS RAVAGING NURSING HOMES ACROSS THE COUNTRY.
But the week before, New York Gov. Andrew Cuomo and his health commissioner, Howard Zucker, had all but made such discharges mandatory. If a hospital determined a patient who needed nursing home care was medically stable, the home had to accept them, even if they had been treated for COVID-19. Moreover, the nursing home could not test any such prospective residents — those treated for COVID-19 or those hospitalized for other reasons — to see if they were newly infected or perhaps still contagious despite their treatment. It was all laid out in a formal order, effective March 25. New York was the only state in the nation that barred testing of those being placed or returning to nursing homes.
In the weeks that followed the March 25 order, COVID-19 tore through New York state’s nursing facilities, killing more than 6,000 people — about 6% of its more than 100,000 nursing home residents. In all, as many as 4,500 COVID-19 infected patients were sent to nursing homes across the state, according to a count conducted by The Associated Press.
The state declined to say if it knew how many COVID-19 patients had been sent or returned to Diamond Hill. Officials with Diamond Hill refused to disclose the number.
By June, 18 of Diamond Hill’s residents had died from the virus and 58 had been infected. At least 50 of the facility’s more than 100 workers had also been sickened with COVID-19.
As Deaths Mounted at Diamond Hill, New COVID-19 Patients Were Transferred In
Source: Rensselaer County Department of Health
States that issued orders similar to Cuomo’s recorded comparably grim outcomes. Michigan lost 5% of roughly 38,000 nursing home residents to COVID-19 since the outbreak began. New Jersey lost 12% of its more than 43,000 residents.
In Florida, where such transfers were barred, just 1.6% of 73,000 nursing home residents died of the virus. California, after initially moving toward a policy like New York’s, quickly revised it. So far, it has lost 2% of its 103,000 nursing home residents.
The decision by Cuomo and Zucker, whose department regulates all nursing homes in the state, drew fire as soon as it was announced from medical experts, nursing home operators and the families of residents. Cuomo himself had said protecting nursing home residents was the state’s top priority, once calling the threat “fire through dry grass.”
Steve McLaughlin, the county executive where Diamond Hill is located, viewed the state’s directive as madness and chose to defy it, refusing to allow any COVID-19 patients to be returned to, or placed in, the one nursing home run by the county. The 320-bed facility, Van Rensselaer Manor, has not seen a single COVID-19 death.
Cuomo and New Jersey Gov. Phil Murphy have defended their approach as a way to open up crucial beds at a moment when it appeared hospitals would be overwhelmed by COVID-19 patients needing intensive care.
Charles Branas, who leads the epidemiology department at Columbia University’s Mailman School of Public Health, said he could appreciate New York state’s concern about a shortage of hospital beds in hard-hit areas.
“The New York state advisory looks like it was intended as a ‘reverse triage’ strategy to clear acute and critical care hospital beds, regardless of whether those beds had people with COVID-19 or not,” Branas said. “Possibly, the positive trade-off they had in mind with the policy was that more lives would be saved with additional open critical care beds than would be lost in transfer to nursing homes.”
But Branas said he believes the policy could well have increased New York’s COVID-19 death toll by a magnitude that will be determined by future researchers. “If you introduce 4,500 people sick with a potentially lethal disease into a vulnerable and notoriously imperfectly monitored population,” he said, “people are apt to die.”
Former employees and families of patients portray Diamond Hill as a case study of a facility ill-prepared to cope with the complexities of containing the virus. The day Gilmore was told of the resident with COVID-19, she said she was also told that the information should not be shared with other staffers or patients — the management didn’t want to provoke panic. Gilmore said she refused to go along and was later fired.
Three days after Diamond Hill was informed of its first case, six other residents tested positive, suggesting the virus had been present at the home for days, maybe weeks. The resident with COVID-19 who was returned to the home might have provided more fuel for the virus’s spread.
Gilmore said the home made inadequate adjustments to try to care for its residents’ safely. The COVID-19 patients were not isolated in a separate unit, and the facility lacked adequate protective gear for staff, she said. Gilmore and county officials said staffers who’d been exposed were encouraged to break their quarantines and return to work.
All told, the virus has claimed the lives of nine women and nine men at Diamond Hill, three younger than 60, three older than 90. Among those lost: a church deacon, a bowling alley manager, a former nurse and a beloved grandfather called Pop Pop by his grandchildren.
“Uncalled for, unnecessary, should never have occurred, and wouldn’t have but for a tragically misguided order from the state,” McLaughlin, the Rensselaer County executive, said of the outcomes at Diamond Hill.
The state Health Department said its personnel visited the home at least twice in April as part of broader efforts to track and control the virus inside the state’s nursing homes. They deemed Diamond Hill capable of caring for its residents. Documents show Zucker, the health commissioner, was fully aware of events at Diamond Hill and reassured local leaders that the department had offered help moving patients to other facilities, but was told it wasn’t needed.
Cuomo and Zucker, after escalating criticism, revoked the March 25 directive on May 10.
The Cuomo administration would not say who conceived of the order or answer the question of whether it believed the order had led to additional deaths. The administration said the Health Department was conducting “a thorough review” of COVID-19’s impact on nursing homes.
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