COVID Fatality Rates: A Different Perspective

Fatalities attributed to the Wuhan virus have been measured in a variety of ways. Most commonly, fatalities per 100,000 population are cited. Then, too, people sometimes note the prevalence of elderly people in states like Florida as a relevant factor.

The most relevant factor, however, would seem to be nursing home population. A large percentage of covid-attributed deaths, in some states well over half, have occurred in congregate care settings–nursing homes and assisted living facilities. It occurred to me to wonder whether states vary much in the percentage of people in nursing homes, and if so, whether that helps to explain differences in fatality rates.

Nursing home residents are particularly vulnerable to covid, both because of the likelihood of transmission in a group setting, and also because nursing homes are the residence of last resort. I understand that for the average person who enters a nursing home, life expectancy is measured in months. Such individuals are particularly vulnerable to a respiratory virus like the Wuhan flu, which most healthy people apparently do not even notice.

It turns out that nursing home populations, on which data are readily available, are quite variable. I used the numbers at the link, together with CDC numbers on covid deaths, to calculate deaths as a percentage of nursing home population. The results are interesting, and paint a different picture from what we usually see.

I started with the five Upper Midwestern states, which I have followed rather closely through the Wuhan epidemic. Minnesota and Wisconsin have followed more or less opposite strategies (Minnesota closed down, Wisconsin relatively free), yet their fatality numbers have been virtually identical. Meanwhile, the other Upper Midwestern states, Iowa, North Dakota and South Dakota, have reported higher per-100,000 death rates than Minnesota and Wisconsin. They, too, have followed widely diverging policies. But it turns out that there are a lot more nursing home residents per capita in Iowa, North Dakota and South Dakota than in Minnesota and Wisconsin. I speculate that Minnesota’s and Wisconsin’s poor tax policies have driven some who would otherwise reside in nursing homes there to other states.

Here are the deaths per nursing home residents for the Upper Midwestern states:

Minnesota: 0.254
Wisconsin: 0.278
Iowa: 0.193
North Dakota: 0.260
South Dakota: 0.292

Iowa, in particular, goes from being a worse-than-average state in per capita deaths to an above-average state in deaths per nursing home resident. Otherwise, however, the numbers are more or less interchangeable.

Florida is an interesting case. It has a lot of old people, the second highest rate in the country. But its per capita nursing home population is not commensurately large. Here are the numbers for Florida and some other states, more or less randomly selected:

Florida: 0.337
New York: 0.452
Illinois: 0.305
Utah: 0.266
Washington: 0.259

Utah and Washington are also interesting cases. They both look like great performers when deaths per capita are measured, but they have relatively few nursing home residents. On these numbers, their performance is closer to average.

California: 0.330
Texas: 0.351
Michigan: 0.391
Ohio: 0.141
Pennsylvania: 0.265
Louisiana: 0.312

On this measure, Ohio stands out with excellent numbers, and nothing can help Andy Cuomo’s New York disaster. But in general, the numbers don’t deviate too much. This is consistent with the growing body of evidence that suggests mitigation measures–shutdowns and mask mandates–don’t make a lot of difference.

This is a crude measurement, obviously. In particular, it is important to note that I am not trying to measure the number of nursing home residents who have died. Someone, somewhere, has probably done this, but I haven’t seen it. These calculations simply illustrate the fact that nursing home populations vary rather widely from state to state, and taking that factor into account helps to explain the differences in fatality rates among states.