More than 68,000 COVID-19 cases and 16,000 deaths among nursing home residents are not reported in federal data, a new study suggests.
Harvard University researchers compared federal data with local data for 20 states with comprehensive information on Covid in nursing homes dating back to the start of the pandemic — before facilities were required to report to the federal government.
They found that, on average, 44 percent of cases and 40 percent of deaths counted by states before the end of May 2020 were not included in federal data collected by the Centers for Disease Control and Prevention (CDC).
This suggests that “the true toll of COVID-19 on nursing home residents may never be known,” noted a scientist not involved in the study.
More than 68,000 Covid cases and 16,000 deaths are not listed in federal data, a new study suggests. Pictured: A pharmacist administers a Covid vaccine to a resident of the Brooklyn Center for Rehabilitation and Healthcare in New York City, January 2021
Many of the unreported cases and deaths occurred in the early months of the pandemic, before nursing homes were required to report their Covid data to the CDC. Pictured: light blue indicates cases and deaths reported to the federal government and dark blue indicates how much higher the bars should be
The first major Covid outbreak in the US occurred at a nursing home in Kirkland, Washington, in late February 2020.
More than 120 people became ill in this outbreak, including 81 residents, 34 staff and 14 visitors, according to a CDC study.
The outbreak foreshadowed the disproportionate impact the pandemic would have on nursing homes and other long-term care facilities.
According to estimates from the COVID Tracking Project, nearly one in ten nursing home residents died of Covid during the first year of the pandemic.
While the known death toll is catastrophic, a new study suggests federal data seriously underestimates how many nursing home residents got sick or died.
This study by researchers at Harvard University was published Thursday in the JAMA Network Open.
The researchers compared nursing home data from the CDC’s National Healthcare Safety Network (NHSN) with data from 20 state health departments.
Although Covid began to affect U.S. nursing homes in February, the federal government did not require these facilities to report their Covid cases and deaths until the end of May 2020, the researchers said.
Facilities were also not required to post-report cases and deaths that occurred early in the pandemic.
For example, the Kirkland, Washington nursing home reported zero cases to the CDC in May 2020 — even though it was the site of a major outbreak.
By contrast, some states — including all 20 state public health departments whose data the Harvard researchers used — required nursing homes to report all cases and deaths, going back to the start of the pandemic.
However, the researchers noted that state data varied significantly — with different definitions of Covid cases and some states, including other types of pooled care facilities.
When comparing this state data with the data from the CDC, the researchers found significantly higher numbers of cases and deaths in those facilities that reported all Covid cases from the start of the pandemic.
In December 2020, the state and federal numbers were closer together — but about 14 percent of cases and 19 percent of deaths from state data remained unreported in federal data. Pictured: light blue indicates cases and deaths reported to the federal government and dark blue indicates the adjusted measure
Underreporting varied by state, based on state requirements for nursing homes to report their Covid cases and deaths
All in all, prior to the federal reporting requirement at the end of May 2020, 44 percent of Covid cases counted across the 20 states were not reported by the CDC.
During that same period, 40 percent of Covid deaths went unreported by the federal government.
Underreporting of cases ranged from 40 to 60 percent, while reporting of deaths ranged from 30 to 50 percent among the 20 states analyzed.
By the end of 2020, a total of 14 percent of cases and 19 percent of deaths reported by the 20 states remained unreported in the CDC’s data.
The researchers extrapolated their findings from these 20 states to the rest of the country.
They estimate that a total of 68,213 cases and 16,623 deaths among nursing home residents are not included in the federal government data.
That represents about 12 percent of total cases and 14 percent of total deaths in nursing home residents.
Nursing homes in different regions, under different owners and with different quality ratings showed similar levels of underreporting, suggesting that this was a problem for facilities across the board.
But some states matched federal data better than others.
New York was one of the few states where the federal nursing home’s Covid number outnumbered states — even though this state was an early epicenter of the pandemic — suggesting there’s far too little going on at the end of the state government. counted.
Using raw federal data, the researchers said, New York appears to have similar nursing home death rates to California.
However, after taking into account unreported deaths, we estimate that New York nursing homes experienced 9,276 deaths (8.1 deaths per 100 beds), compared to 6,487 in California (5.5 deaths per 100 beds), the researchers wrote.
Former New York Governor Andrew Cuomo has faced criticism and investigations over his cover-up of Covid deaths in nursing homes.
This study shows how many nursing home cases and deaths went uncounted, especially in federal data.
“The real toll of COVID-19 on nursing home residents may never be known,” Elizabeth White, a public health researcher at Brown University unaffiliated with the study, wrote in a commentary to JAMA Network Open.
“The most accurate data sources for nursing home cases and deaths during the first U.S. wave of the pandemic are state health departments,” White said.
“Yet only about half of U.S. states collected and publicly released Covid data from nursing homes in the spring of 2020, and these states varied widely in the amount and quality of the information reported.”
White also noted that researchers using the CDC’s nursing home data should consider the significant underreporting in future studies.