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Nursing Home Residents Die From COVID at Record Rate Over New Year’s Period

Almost 20,000 dead in just four weeks, for the second month, new AARP analysis shows


The COVID-19 death rate in U.S. nursing homes hit a new high in the weeks surrounding New Year’s Day, a new AARP analysis of federal data shows. It found that roughly 1 in every 51 residents died from COVID-19 over the four-week period from Dec. 21 to Jan. 17. A total of 19,299 deaths were reported. 

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The death rate captured in the analysis topped that of previous four-week reporting periods, making it the highest COVID-19 death rate reported to the government since the Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to do so in late May. 

While the record high death rate in the four weeks ending Jan. 17 represents only a slight increase from the previous month, when 1 in every 53 residents died from COVID-19, it is more than a quadrupling of the resident death rate at the end of the summer. 

Twenty-three states and Washington, D.C., saw their resident death rates climb from the previous four-week reporting period, the analysis shows. Indiana recorded the highest death rate in the U.S., with roughly 1 in every 28 residents having died from COVID-19.

The analysis also shows that for the first time in months, the national rate of new COVID-19 infections among both residents and staff of nursing homes is coming down. Cases dropped slightly, from roughly 1 in every 9 residents between mid-November and mid-December to roughly 1 in every 11 residents between mid-December and mid-January. The infection rate also dropped slightly among nursing home staff, from around 1 staff infection for every 11 residents to 1 for every 12 residents for the same reporting periods.

It’s welcome news, given that nursing homes, along with other long-term care settings such as assisted living facilities, have been disproportionately affected by the COVID-19 pandemic. As of Feb. 4, almost 162,000 residents and staff of long-term care facilities have died from COVID-19, according to the COVID Tracking Project, accounting for roughly 36 percent of all U.S. COVID-19 fatalities.

But although the case rates dropped, they are still “staggeringly high,” says AARP’s Ari Houser, a senior methods adviser and coauthor of the new analysis. More than 170,000 new COVID-19 cases were confirmed in nursing homes between mid-December and mid-January. “That’s still more than three times as high as the rates in late summer and early fall,” he adds. And while the national outlook shows some progress, he notes that a third of all states are still experiencing increases in case rates. 

What’s driving declining COVID infections?

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One of the major drivers of COVID-19 outbreaks in nursing homes is community spread; even if a facility puts a stop to visits, as many have, nursing home staff often become infected in their communities and introduce the virus into their workplaces. 

“You can do as much as you can to try and keep the virus out of nursing homes, but the more transmission there is in the community, the more chances there are for the virus to get it,” says Justin Lessler, an associate professor of epidemiology at the John Hopkins Bloomberg School of Public Health.

Lessler says that a mix of state and county restrictions and natural herd immunity could be contributing to declining infections. “During the big COVID surges, control measures were put in place,” he says. “Some places had some fairly vigorous control measures — they reduced community transmission. Combined with the accumulated immunity in the population, [they have] been enough to turn the corner.”

Natural immunity among nursing home residents is likely quite high, AARP’s Houser says. “Hundreds of thousands of new infections have been reported for several months now. If you have more than 1 in 10 residents infected in one month — as high as 1 in 5 in some states — then a similarly high rate the next month, as well as cases throughout the spring, summer, and fall ... it adds up,” he says.

More than 1 million infections have been reported in nursing homes over the course of the pandemic, according to CMS data. “So many people have already gotten COVID that we have reached a point where the pool of people in nursing homes who can get newly infected is much smaller, and this is likely contributing to the decline in new cases” Houser says.

What about the COVID-19 vaccines?

A federal partnership with CVS, Walgreens and other pharmacies delivered the first shots of two-dose vaccines from Pfizer and Moderna to residents and staff of nursing homes starting late last year, which happened ahead of the broader public vaccination effort. The program finished its first round of shots in late January, but the effects wouldn’t have shown up in the new analysis because its reporting window closed on Jan. 17. 

“Right now, there’s still a ton more natural immunity out there than there is vaccine-derived immunity,” says Lessler, noting that a second dose of the vaccines is needed for optimum immunity. Only 37.5 percent of staff accepted their offer to receive a vaccination ahead of almost everyone else in America, whereas more than 78 percent of residents did. 

The facilities should soon start to see dramatic declines in cases and deaths compared with the general population, Lessler says. “To see that strongly, though, we’re depending not only on the residents to get vaccinated, but the staff as well. If the staff aren’t vaccinated, they remain a way that the virus can quite literally enter the building.” 

AARP’s analysis, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data acquired from the Nursing Home COVID-19 Public File by CMS. Nursing homes are federally certified and are required to submit data to the government each week. 

The ongoing analysis focuses on five key categories of COVID-19 impacts: resident cases, resident deaths, supply of personal protective equipment (PPE), staff cases and staff shortages. It captures data only from federally certified nursing homes, not from all long-term facilities (such as assisted living, independent living, memory care and others), as some other tallies do. An updated analysis will be released next month as new federal data becomes available.

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