We still don’t know the true death toll from COVID in NY nursing homes

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After a damning report from New York Attorney General Letitia James this week, Gov. Cuomo and his staff finally released mortality data that adds to the toll that COVID-19 has taken on the state’s nursing-home residents. It’s a start — but it mustn’t be the end of it: The state needs to keep critical nursing-home data coming, and on a timely basis.

On Thursday, New York’s attorney general released a review in which she estimated the total number of nursing-home residents who have perished from COVID-19 has been undercounted by the Department of Health by more than 50 percent. Shortly afterward, Health Commissioner Howard Zucker finally released long-sought information about the number of nursing-home residents who died from the disease after having been transferred to the hospital.

As a result, the contentious issue of the department’s management of COVID-19 in this setting has catapulted to the top of the news cycle again, especially as related to the infamous March 25 directive that nursing homes must accept COVID patients for admission.

Yet as outrageous as it was to be kept in the dark for so long about the number of residents who died of the disease after being transferred to hospitals, even more shocking is that we continue to ignore trends about current, ongoing nursing-home deaths. Why is it that we are not informed about whether or not residents are dying at the same rate now as they did in the spring? Are the numbers going up, down or sideways?

You certainly won’t learn anything about this issue from Gov. Cuomo’s press conferences. In these, he covers in exquisite detail the rolling seven-day average of COVID patients in our hospitals, how many are intubated and what percentage of ICU beds remain. This information is then very helpfully broken down by region.

He does the same with the percentage of positive COVID test results, sometimes described down to the ZIP-code level, making sure we know exactly where, at any given moment, people are being naughty and deserving of scolding.

But why aren’t we similarly informed about what is going on in our nursing homes? Instead, the number of nursing-home residents who die on a daily basis — which used to be regularly acknowledged — is no longer even mentioned or questioned.

Only by visiting the Center for Disease Control’s National Healthcare Safety Network Web page will you realize, for example, that this month New York experienced the highest rate of nursing-home deaths since May, when the CDC first started reporting the information. While this doesn’t include the statistics from the terrible early weeks of the pandemic, the rate is double the highest level reported in the spring. It is utterly shocking that this has not been acknowledged.

Why aren’t we told about the seven-day rolling average of positive test results in our nursing homes ? Or deaths? Why aren’t we informed about the regions, counties and ZIP codes in which nursing-home infections and fatalities are occurring? How can we possibly know whether or not our strategy against this insidious enemy, known to specifically prey on this vulnerable population, is actually working?

The governor recently said, “We are at war with COVID.” Well, the nursing homes are the battlefields in which close to half the casualties continue to occur. If we are to have any chance of winning this war, we must make sure to keep the issue of nursing-home COVID infection and death rates in prominent view.

Statistics about this demographic must be posted on the state’s Web site, analyzed by the Department of Health’s epidemiologists, included in its provider webinars and covered in the governor’s press conferences on an ongoing basis. Reporters must inquire about it if that doesn’t occur.

What happened in the state’s nursing homes in the spring was tragic, and the suffering was compounded by a lack of communication and transparency; we can’t allow the same to occur going forward.

Fact is, we can’t improve upon something we don’t know about. If we don’t keep a light on what is going on in our nursing homes, COVID-19 mortalities in this setting will continue to mount.

Elaine Healy is a geriatrician, nursing-home medical director and member of the Infection Control Subcommittee of the Society for Post-Acute and Long Term Care Medicine.

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