Nursing homes didn't report 40% of early COVID-19 cases

An estimated 44% of COVID-19 cases and 40% of COVID-19 deaths that occurred in nursing homes before May 24, 2020 were not reported to the federal government, according to new research.

The Trump administration did not start requiring nursing homes to report COVID-19 cases and deaths until May 24, 2020, and facilities could choose whether to report retroactive data. The gap in national reporting has made it difficult to determine national COVID-19 case and death counts.

"The start of federal reporting was relatively late into the pandemic," said Karen Shen, an author in the study released Thursday in JAMA Network Open. "Because of that, it's been hard to actually have a reasonable estimate for the toll of COVID-19 on nursing homes for the entire pandemic."

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Using data submitted to the National Healthcare Safety Network and information submitted to state departments of health, researchers estimated that 68,613 COVID-19 cases and 16,623 COVID-19 deaths that occurred before May 24, 2020 have not been reported nationally. Those cases and deaths represent 12% and 14% of total nursing home cases and deaths, respectively, the study found.

"These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks," the authors wrote.

For example, Life Care Center of Kirkland in Washington, where the first COVID-19 outbreak in a nursing home occurred, reported zero cumulative COVID-19 cases in its first NHSN submission, even though the CDC had reported there were 81 cases and 25 deaths associated with the early outbreak.

Understanding accurate case and death counts will allow researchers to better analyze early COVID-19 response policies and how those differed at the state and federal level, said Shen, an economist at the not-for-profit Research Improving People's Lives.

The American Health Care Association/National Center for Assisted Living said it has fully supported public reporting and transparency since the start of the pandemic.

"We encourage state and federal officials to improve our nation's data collection and sharing efforts during public health emergencies, so that we streamline processes for providers and offer more comprehensive, real-time information that can help inform our response," AHCA/NCAL said in a statement. "Extensive research shows that community spread has been the main driver of outbreaks in nursing homes, not quality ratings or ownership status. Unfortunately, at the beginning of the pandemic, public health officials at every level took months to direct the needed support to long-term care facilities despite caring for our nation's most vulnerable, which had devastating consequences."