This paper examines domestic abuse during the stay-at-home efforts. (Medrxiv Paper) As the authors note, particularly in regard to children, a decrease in reporting may be a sign of trouble, as much child abuse is actually reported from school or medical personnel who observe the signs or learn of it. And spouses, when trapped at home, may also feel less comfortable reporting. The authors used data from Chicago to track any changes in trends during the epidemic and the lockdowns, with March 2019 being a comparison month. There were slightly fewer total reports of domestic abuse or violence in 2020 and there was little absolute change before and after the stay-at-home order, but there was a 22% increase in reports of domestic violence during the pandemic. In addition, it was 64% more likely that there was domestic violence in a residential setting and 67% less likely that it involved a child during the stay-at-home order. That is a frightening finding because it suggests that increased violence against children almost certainly was not being reporting, as you might expect. Parents are unlikely to call and say I, or a spouse, just beat my child up. While there appears to have been less domestic violence, as the authors suggest, this is almost certainly due to fear of reporting or inability to report.
One observation from today’s health department briefing was a discussion of the department’s intent to break long-term care cases and deaths into components like skilled nursing facilities. They are doing this primarily because of intense attention focussed on the fact that Minnesota has such a high percent of all deaths occurring in these settings. The department quite rightly points out because there is not comparability to statistics from other states in what is categorized as a long-term care death, Minnesota may look like it is doing worse than it is. There are now national numbers reported by the Centers for Medicare Services on skilled nursing facility deaths. (CMS Data) There may still be issues with the quality of this data due to inconsistent reporting, but hopefully it will get better over time. Overall about 80% of nursing homes had reported cases and deaths to CMS, as is now required. Don’t know if that represents 80% of residents. The reporting as of earlier this week listed 60,000 cases and 26,000 deaths. So the likely real national total is over 30,000. According to this data, as of May 24, Minnesota nursing homes had reported only 297 deaths. It is unclear what percent of nursing homes, accounting for what percent of residents, had reported, but based on national numbers I would estimate the real total of deaths is around 375, less than half the total the state reports for long-term care. The variation in death rates across states is very significant. Don’t know if that reflects better controls or less population density, policies about returning recovering coronavirus patients to the homes or other factors.
Once Minnesota makes the data more granular, we may be able to make some inferences about the total number of deaths in senior and other group living settings nationally, which would also be revealing. I strongly suspect that an accurate count would show that nationally probably 60% to 70% of all deaths are occurring among these groups. Right now, based on Minnesota data, you would estimate that there have been over 60,000 to 70,000 deaths in the congregate living settings, which would in fact hit those numbers I suspect exist. If so, it means that the risk to the general population is even lower that it has appeared. And we still need an accurate count of deaths occuring among people with advance directives and/or in end-of-life programs. That will make the total percent accounted for even higher. It will absolutely be the case that the risk to the general population living in the community from coronavirus is less than that from influenza.
And here is some interesting data I ran across from the census bureau. They are doing household “pulse” surveys to understand changes occurring during the pandemic and lockdown. (US Census Bureau Tables) There are some fascinating tables here. The ones on education and health care are very useful. You can see that the reality is that kids aren’t getting the same education at home. At since this is self-reported data, it is almost certainly exaggerated. But children are definitely getting a lot less supervised education even if the data is accurate. And it appears, as usual, that closing schools hurt low-income and minority students the worst. There is Minnesota specific data there as well. On the other hand the skipping health care data is likely more accurate and the Bureau estimates that 88 million Americans skipped medical care because of the pandemic and 71 million did it for needed medical care unrelated to coronavirus. An astounding number of people say they are anxious or worrying all the time. (Thanks for fear-mongering Governor Walz and others.) 119 million Americans said they have experienced some loss of employment income and 86 million expect to have such a loss in the next four weeks.
Finally, a personal anecdote. An author of a study that I critiqued somewhat harshly contacted me to complain about the summary I wrote. I sent back a longer explanation giving some pretty specific experimental design issues, all of which were pretty standard, and pointing out some other information that suggested the studies findings were likely flawed. The response I got, and this is from a physician, was basically that I was ignoring facts and being political. The person had clearly not even read the email I sent carefully. Now, I am not really surprised, because it is always my experience with people that they aren’t interested in having their beliefs challenged or in listening to facts which aren’t consistent with those beliefs. No one likes to admit they were wrong; it doesn’t concord with our self-image. But the essence of integrity and truth-finding is to be able to admit when you have made a mistake and to be able to look at and absorb honestly all information. It shows you what we are up against, how people, even smart people, just dig in their heels and won’t change course in the face of obvious information that should cause them to change. It is a frustrating but very real aspect of any public policy issue. I can assure you that I work very hard to look at data and research, to apply the knowledge that I have to the data and research findings and come to what I think are appropriate conclusions. And the last thing this is about to me is politics, which I abhor. This is about what we have done to people’s lives, tens and hundreds of millions of lives; damage that will take a decade or more to undo and damage that was totally unnecessary.