Nursing home problem absolutely extends far beyond Europe and America.

NZ have 21 deaths but people gloss over the fact 12 of them from one nursing home (Rosewood in Christchurch), 3 from another nursing home (St. Margaret's in Auckland) and another 2 moved from nursing homes. https://twitter.com/susmitchellSBP/status/1262648388593557506

If you're looking at percentage of overall deaths, the worst affected countries are Canada (82%) and NZ (81%) but Asia didn't escape.

As things stand, almost 40% of South Korea's 263 deaths are in nursing homes (37.6%) but their official stats say 0%.

Ok how does that work?

S. Korea transport all nursing home residents to acute hospitals, which is cruel in many cases. Many in no condition to be moved.

Headline stats therefore show only hospital deaths. Factual but inadequate.

For transparency, Academic research in Seoul:

https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf

South America's nursing homes are being decimated but unfortunately the worst-affected countries of Brazil and Ecuador are neither testing nor counting. You're relying on Brazilian media reports, of which there are dozens such as this one: https://revistaforum.com.br/coronavirus/asilo-tem-28-casos-e-6-mortos-por-coronavirus-no-interior-de-sao-paulo/

The properties of Covid19 are fairly consistent across every geographical region.

It disproportionately kills older people and people with multiple comorbidities (which again, is disproportionately older people).

It's exceptionally difficult to protect those settings.

Nowhere in central or Western Europe managed to protect nursing homes, nowhere in North or South America managed it, Asia did *slightly* better, in part due to their societal reverence for the elderly, but even they failed. Oceania despite their Elimination Strategies failed.

What people fundamentally misunderstand is this isn't a statement that applies just to covid19.

A whole range of preventable viruses and bacteria get into nursing homes every year and people die, who might otherwise have lived a few months longer.

It's just nobody cared.

How world fixes this depends how much people care now.

Jordan was a success story, deserves highlighting.

In Amman, they implemented a rotation of agency staff on a one-week-on, one-week-off basis. Staff didn't leave nursing home for the week, they were accommodated on-site.

That's obviously a big sacrifice from the nurses - e.g. not seeing their kids for a week - but in terms of infection control, nobody leaving the nursing home and then rotating in a new crew of (tested) agency staff, dramatically reduced infection risk.

The week off was spent isolated at home and then they're tested before they resume the next week in a different nursing home.

There's a number of innovative ideas like that being tried elsewhere that we should at least examine the model to see what parts could work here.

It's a truly global problem with no single solution. People myopically focused on PPE don't understand the issues. There's no "Do this and problem solved".

The goal isn't to eliminate nursing home outbreaks of viruses - that is impossible - it's to mitigate the risks of them.