More than 68,000 COVID-19 cases and 16,000 deaths among nursing home residents are unaccounted for in federal data, a new study suggests.
Researchers at Harvard University compared federal data to local data for 20 states with comprehensive information on Covid in nursing homes going back to the beginning 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 the states before late 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,’ a scientist who wasn’t involved with the research commented.
More than 68,000 Covid cases and 16,000 deaths are unaccounted for 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 U.S. occurred at a nursing home in Kirkland, Washington, in late February 2020.
More than 120 people got sick in this outbreak, according to a CDC investigation – including 81 residents, 34 staff, and 14 visitors.
The outbreak foreshadowed the outsized impact that the pandemic would have on nursing homes and other long-term care facilities.
Almost one in ten nursing home residents died of Covid during the first year of the pandemic, according to estimates from the COVID Tracking Project.
While the known death toll is catastrophic, a new study suggests that federal data gravely underestimates how many nursing home residents got sick or died.
This investigation by researchers at Harvard University was published Thursday in JAMA Network Open.
The researchers compared nursing home data from the CDC’s National Healthcare Safety Network (NHSN) to data from 20 state health departments.
Although Covid began impacting U.S. nursing homes in February, the federal government did not require these facilities to report their Covid cases and deaths until late May 2020, the researchers said.
Facilities also weren’t required to retrospectively 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 had been the site of a large outbreak.
Some states, on the other hand – including all 20 state public health departments whose data the Harvard researchers utilized – required nursing homes to report all cases and deaths, going back to the beginning of the pandemic.
The researchers noted that state data varied significantly, though – with different definitions of Covid cases and some states including other types of congregate care facilities.
Upon comparing this state data to the CDC’s data, the researchers found significantly higher case and death numbers in those facilities that reported all Covid cases back to the start of the pandemic.
By December 2020, state and federal numbers were closer together – but about 14 percent of cases and 19 percent of deaths from state data remained unreported in the 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
Overall, prior to the federal reporting requirement in late May 2020, 44 percent of Covid cases counted by the 20 states went unreported by the CDC.
In that same period, 40 percent of Covid deaths went unreported by the federal government.
Case underreporting ranged from 40 to 60 percent, while death reporting ranged from 30 to 50 percent among the 20 states analyzed.
By the end of 2020, overall, 14 percent of cases and 19 percent of deaths reported by the 20 states remained unaccounted for in the CDC’s data.
The researchers extrapolated their findings from these 20 states out to the rest of the country.
They estimated that, in total, 68,213 cases and 16,623 deaths among nursing home residents are not included in the federal government’s 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 more closely than others.
New York was one of very few states where federal nursing home Covid numbers were higher than state numbers – even though this state was an early epicenter of the pandemic – suggesting a lot of undercounting on the state government’s end.
Using raw federal data, the researchers said, New York would appear to have similar nursing home death numbers to California.
‘However, after accounting for unreported deaths, we estimate that nursing homes in New York experienced 9,276 deaths (8.1 deaths per 100 beds), compared with 6,487 in California (5.5 deaths per 100 beds),’ the researchers wrote.
Former New York Governor Andrew Cuomo faced criticism and investigations into his coverup of Covid deaths in nursing homes.
This study demonstrates just how many nursing home cases and deaths have gone uncounted, especially in federal data.
‘The true toll of COVID-19 on nursing home residents may never be known,’ wrote Elizabeth White, a public health researcher at Brown University who was not affiliated with the study, in a commentary at JAMA Network Open.
‘The most accurate data sources for nursing home cases and deaths during the initial US wave of the pandemic are state health departments,’ White said.
‘Yet only approximately half of U.S. states collected and publicly released nursing home Covid data during Spring 2020, and these states varied widely in the amount and quality of information reported.’
White also noted that researchers using the CDC’s nursing home data must take the significant underreporting into account in future studies.
