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Protecting the Vulnerable: The 80/20 Rule and COVID

The 80/20 rule was originally coined by Vilfredo Pareto an Italian economist. He famously said that for many events, 80% of the effects are driven by 20% of the causes. And while the numbers 80/20 may not always hold, this principle of cause and effect shows up in many complex systems and events.

We can clearly see this with COVID.

We discussed in our last post that the elderly are uniquely vulnerable to COVID. Patients over the age of 80 being up to 12 x more vulnerable. The New York Times today reported on the percentage of deaths that are being driven by nursing home residents. Their findings:

  • Across the country, nursing home residents are 11% of the cases and 33% of the deaths
  • In many states (Maryland, Virginia, Delaware, Pennsylvania), nursing home residents constitute over 50% of the cases
  • In states where deaths are lower, there are almost assuredly reporting issues (e.g., New York). Because of the reporting issues the exact numbers are not clear, but other analyses of the data has shown almost 40-50% of cases nationwide driven by nursing homes.

So let’s call it the 50/10 rule instead of 80/20.

Policies have almost assuredly exacerbated this problem including:

  • Discharging nursing home patients out of the hospital back into the nursing home (driven by reimbursement reasons)
  • California, New York and New Jersey had policies requiring nursing home patients to accept COVID positive patients upon discharge. This is the equivalent of throwing a match onto kindling.
  • Not testing all residents and workers within a nursing home

It would not take much time to test everyone in a nursing home! The CDC estimates that there are 1.7M beds in the country. Current US testing capacity is about 250k a day and projected to double shortly. Testing workers in the nursing home

Whatever your politics, focusing public health efforts on the most vulnerable is evidence-based. It is easier to do, and it would get maximum results. It just makes sense.

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