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“The true toll of COVID-19 on nursing home residents” in the US may never be known

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A new analysis estimates that more than 68,000 COVID-19 cases and 16,000 deaths among nursing care residents are unaccounted for in federal data.

Harvard University researchers reviewed federal and local data for 20 states that included detailed information on Covid in nursing homes dating all the way back to the outbreak’s start – before facilities were obligated to report to the federal government.

They reported that 44 percent of cases and 40 percent of deaths reported by states before to late May 2020 were not included in federal statistics gathered by the Centers for Disease Control and Prevention (CDC).

This indicates that the ‘true toll of COVID-19 on nursing home residents may never be known,’ according to a scientist who was not involved in the research.

The first significant Covid outbreak in the United States happened in late February 2020 at a nursing facility in Kirkland, Washington.

According to a CDC study, this outbreak sickened more than 120 persons, including 81 residents, 34 staff members, and 14 visitors.

The incident hinted at the pandemic’s detrimental impact on nursing homes and other long-term care facilities.

According to estimates from the COVID Tracking Project, nearly one in every 10 nursing home residents died of Covid during the first year of the pandemic.

While the reported death toll is staggering, a recent analysis indicates that federal data significantly underestimates the number of nursing home residents who became ill or died.

This study, conducted by Harvard University researchers, was published Thursday in JAMA Network Open.

The researchers compared data from the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC) with data from 20 state health departments.

Although Covid began affecting nursing homes in the United States in February, the federal government did not force these facilities to disclose Covid instances or deaths until late May 2020, according to the study.

Additionally, facilities were not compelled to report cases and deaths that happened early in the pandemic retroactively.

For instance, in May 2020, the Kirkland, Washington nursing home reported zero cases to the CDC – despite the fact that it had been the scene of a significant outbreak.

On the other hand, some states – including all twenty state public health departments whose data the Harvard researchers analysed – required nursing homes to report all cases and deaths dating all the way back to the outbreak’s start.

The researchers highlighted, however, that state data differed greatly – some states used various definitions of Covid cases, while others included other forms of congregate care facilities.

When the researchers compared this state data to the CDC data, they discovered considerably higher case and mortality rates in those hospitals that reported all Covid cases back to the start of the pandemic.

In total, 44 percent of Covid cases counted by the 20 states went unreported to the CDC prior to the federal reporting deadline in late May 2020.

During the same time period, the federal authorities failed to report 40 percent of Covid deaths.

Case underreporting ranged between 40 percent and 60 percent, whereas death reporting varied between 30 percent and 50 percent among the 20 states evaluated.

By the end of 2020, the CDC’s data showed that 14 percent of cases and 19 percent of deaths recorded by the 20 states remained unaccounted for.

The researchers generalized their findings from these twenty states to the rest of the United States.

They estimated that the federal government’s data excludes 68,213 cases and 16,623 deaths among nursing home residents.

This accounts for around 13 percent of total cases and 14 percent of total deaths among nursing home residents.

Nursing homes in different locations, with different owners, and with varying quality ratings all demonstrated similar levels of underreporting, implying that this was a widespread problem.

However, some states’ data more closely matched federal data than others.

New York was one of just a few states where federal nursing home Covid counts exceeded state counts – despite the fact that this state was an early epicentre of the pandemic – implying widespread undercounting on the part of the state government.

According to the researchers, based on raw federal statistics, New York appears to have a similar rate of nursing home deaths 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 came under fire and was investigated for covering up Covid deaths in nursing homes.

This study illustrates the staggering number of nursing home cases and deaths that have gone unreported, particularly in government 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.”

Image Credit: GEtty

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