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16,000 Nursing Home Deaths Likely Missing From COVID-19 Count, Study Finds

It suggests 4 in 10 deaths that occurred early in the pandemic aren’t being acknowledged by the feds

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More than 16,000 COVID-19 deaths in U.S. nursing homes have likely been omitted from the official government death count, according to a new study in the journal (JAMA) Network Open. It suggests that 40 percent of resident deaths from the virus in the early months of the pandemic last year have not been captured. And that government data missed 44 percent of COVID-19 nursing home infections during the same time period, mainly in the country’s Northeast.

Published on Thursday, the study compared COVID-19 cases and deaths reported by U.S. nursing homes to the federal government with those reported to 20 state departments of health in late May 2020.

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A shortfall in COVID-19 nursing home deaths and cases was expected, since the federal government didn’t require the nation’s 15,000 nursing homes to report such data until late May 2020, more than three months after the first reported COVID-19 outbreak in a nursing home in Washington state. And once homes were required to report, they were given the option of whether or not to retroactively report cases and deaths from the previous months. 

“For example, The Life Care Center of Kirkland reported zero cumulative COVID-19 cases in the first [federal] submission, despite a March 2020 CDC investigation identifying 81 COVID-19 cases and 23 COVID-19 deaths among residents,” the study’s authors wrote. The Kirkland facility was the site of the first U.S. COVID-19 outbreak last year.

The missing fatalities add up to 14 percent of what the authors of the study estimate to be the true COVID-19 death toll among nursing home residents in 2020. More than 68,000 COVID-19 cases among residents also went unreported during those early months, accounting for almost 12 percent of total cases among nursing home residents in 2020. 

If added to the government’s official count, the study’s estimates would bring the total number of COVID-19 deaths among nursing home residents to more than 151,000. Total cases would increase to almost 750,000. 

“We felt compelled to make sure that, just because the federal government wasn't requiring any reporting of deaths that happened early in the pandemic, that those deaths were counted somehow,” says Karen Shen, study co-author. 

“There’s essentially no record of 4 out of 10 deaths from this period – that is just huge,” says Shen, who just finished her Ph.D. in economics at Harvard University. “And while it’s perhaps not surprising, it feels right that they don’t go unnoticed.” 

Neglected Northeast

The majority of deaths and cases omitted from the federal count occurred in the Northeast, the study found, which was hit hardest by the coronavirus during the spring 2020 surge, when the federal government wasn’t yet requiring COVID-19 data from nursing homes. 

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In Connecticut, Massachusetts, New Jersey and Rhode Island, state data reported much higher cases and deaths than the federal data. The federal data implied that similar numbers of nursing home residents died in New York and California in 2020 — 5.0 deaths per 100 beds in New York and 4.8 deaths per 100 beds in California. But after accounting for unreported deaths, the study found that nursing homes in New York saw 8.1 deaths per 100 beds, compared to California’s 5.5 deaths per 100 beds. 

AARP advocated for the collection and publication of up-to-date COVID-19 data on nursing homes in the early stages of the pandemic, so the virus’s spread could be better tracked, and resources could be better distributed to the homes in need. 

“We’ve known since very early on that there was a big gap here,” says Ari Houser, senior methods advisor for the AARP Public Policy Institute. “So, while it’s nice to see that we now have numbers with some more rigor and confidence, it’s really confirming what we knew all along, which is that significant deaths occurred in March, April and May of last year that are not being counted by the government.” 

The study’s authors published their findings “in the hope that others can actually start to understand what sort of early response measures were effective at the facility level during those early days,” Shen says. 

COVID-19 infections have started increasing again after dramatic drops at the beginning of 2021, a recent AARP analysis of federal nursing home data showed. President Joe Biden has announced that all nursing home workers in facilities that receive Medicaid or Medicare funds will be required to be fully vaccinated against COVID-19. Only 63 percent of workers nationwide were fully inoculated as of Aug. 29.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.

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