DOH Report Attributes COVID-19 Spread in Nursing Homes to Asymptomatic Staff
The Department of Health (DOH) released a report on July 6th that concludes that COVID-19 was more likely to have been introduced into nursing homes by asymptomatic employees than by infected patients admitted from hospitals. Entitled "Factors Associated with Nursing Home Infections and Fatalities in New York State During the COVID-19 Global Health Crisis," the report disputes the claim that the Department’s March 25th directive prohibiting nursing homes from denying admission solely on the basis of COVID-19 infection was to blame for the transmission of the virus in facilities.
Specifically, the DOH analysis found:
- The timing of staff infections correlates with the timing of peak nursing home resident mortality across the state;
- Nursing home employee infections were related to the most impacted regions in the state;
- Peak nursing home admissions occurred a week after peak nursing home mortality, therefore illustrating that nursing home admissions from hospitals were not a driver of nursing home infections or fatalities;
- Most patients admitted to nursing homes from hospitals were no longer contagious when admitted and therefore were not a source of infection; and
- Nursing home quality was not a factor in nursing home fatalities.
The report found that nearly 7,000 nursing home workers infected with COVID-19 were working in facilities in the month of March, and roughly 20,000 were COVID-19-positive by the end of April. Interestingly, independent testing done by BioReference in May showed that 29 percent of nursing home employees surveyed had COVID-19 antibodies. Eighty percent of all infected nursing home staff were from the most impacted areas of the state: New York City (48 percent), Long Island (17 percent), and the Mid-Hudson Valley (15 percent).
DOH compared the timing of peak staff infections with peak resident mortality and concluded that, given the timing of the respective peaks and the average time from symptom presentation to death, it is likely that employees who were infected in March unknowingly transmitted the virus to residents who died during the peak mortality period in early April. The report explained that early in the COVID-19 pandemic, public health experts believed that asymptomatic people did not spread the disease, and under Centers for Disease Control and Prevention (CDC) guidance, asymptomatic positive or presumed positive employees were allowed to continue to work. Later in the crisis, experts were forced to reverse their position as evidence grew that asymptomatic people could transmit the disease.
To rebut the claim that the State’s March 25th nursing home admission directive led to the spread of infections in facilities, the Department conducted a survey of nursing home admissions. According to the survey, most of the nursing homes that admitted COVID-19-positive patients already had COVID-19-positive residents in their facilities. In addition, the data showed that approximately 6,326 COVID-19-positive residents were admitted to facilities between March 25, 2020 and May 8, 2020. The peak date that COVID-19-positive residents entered nursing homes was April 14, 2020, a week after peak mortality in New York’s nursing homes on April 8, 2020. Based on these data, the Department concluded that admissions did not drive fatalities; if they had, the order of the peak fatalities and peak admissions would have been reversed.
In an effort to further defend the March 25th admission order, the report points to the creation of alternative care sites in New York City, Buffalo, and Syracuse and maintains that nursing homes did not have to accept COVID-19-positive patients if they did not believe that they could provide adequate care for them. According to the report, DOH and the Attorney General’s Office are conducting an investigation to determine if nursing homes violated the law by accepting residents whom they could not properly serve.
Notably, the report found that nursing home quality did not play a role in mortality rates. Facilities with higher Centers for Medicare and Medicaid Services (CMS) 5-Star quality ratings had higher mortality rates than those with lower quality ratings (12 percent mortality rate in 5-star, versus 7 percent in the lowest rated). DOH explained that the geographic location of the nursing home and its corresponding rate of community infection had a greater connection to mortality than its performance on quality measures. In addition, the analysis found a relationship between a higher median resident age and an increase in the mortality rate downstate, but not in the rest of the state.
The report notes the comparatively low fatality rate among New York’s nursing home residents. Connecticut had 86 nursing home/long term care resident deaths for every 100,000 people; New Jersey 75 for every 100,000; Massachusetts 74 for every 100,000; and Pennsylvania 35 for every 100,000, while New York had 33 for every 100,000.
Contact: Karen Lipson, firstname.lastname@example.org, 518-867-8838