Coronavirus: California nursing home deaths undercounted? It’s possible, and disturbing, experts say

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By Thomas Peele and Annie Sciacca | Bay Area News Group | May 1, 2020

As the number of senior care home patients and staff who have died of COVID-19 rose Thursday to more than 40 percent of all California deaths attributed to the disease, state health officials revealed they are likely undercounting such cases.

That’s because the state isn’t capturing all deaths that occur after patients are hospitalized. It’s leaving it up to managers of beleaguered facilities to trace what happens when patients go elsewhere for treatment or staff members fall ill and stay home or end up in a hospital.

“This is not as robust of an accounting as we would like,” Kate Folmer, a spokesperson for the Department Health Services, wrote in an email.

According to the latest state data, 818 residents and staff of long-term care facilities have died of COVID-19 as of April 29. That’s 42 percent of the reported 1,943 statewide deaths attributed to COVID-19 that same day.

“I think it could be much higher,” Pat McGinnis, executive director of California Advocates for Nursing Home Reform, said Thursday of the health department statistics. “There has been a lack of transparency from the beginning.”

While the undercounting of deaths attributed to infections in long-care facilities alarmed and angered experts, it’s not the only flaw in how California is tracking the cases and making the information public.

The state posts a list on its health department website showing a “snapshot” of the current infections among nursing home staff and patients reported by facilities in the last 24 hours. But no historical or cumulative data for each facility is included, nor is there any information about outcomes of the cases — whether someone died or recovered.

For example, the state health department reported that of April 17, Gateway Care and Rehabilitation Center in Hayward had a total of 102 COVID-19 cases — 33 staff and 69 patients. But the latest report this week shows there are 26 positive patients and fewer than 11 positive staffers there. State and county health officials have refused to account for difference and will not release the latest death total. The last time the county last released that number on April 16, 13 people had died at the nursing home.

HAYWARD, CA – APRIL 9: A Falck ambulance crew member sprays disinfectant on a gurney outside of the Gateway Care and Rehabilitation Center on Thursday, April 9, 2020, in Hayward, California. (Aric Crabb/Bay Area News Group)

The state didn’t require mandatory daily reporting from nursing homes on cases and deaths until April  17, weeks after major outbreaks in Hayward, Orinda, Riverside and Tulare countries. On April 21, the state released data showing that there were 26 nursing homes statewide that had 50 or more positive cases.

The new data released Thursday showed the number had dropped to seven. Folmer did not respond to a question about what accounted for the drop.

The nursing homes are required to report their cumulative number of cases and COVID-19-related deaths, according to letters issued to the facilities by the state. But the state hasn’t published those numbers or revealed them to this news organization, despite repeated requests.

McGinnis noted that while residents and their families are often told about an outbreak, they get little information about the total number of cases or how many workers in the facilities have the virus. They may see a home where their loved one lives on the state list one day, but days later it disappears from the list without explanation.

“It’s a real disservice,” she said. “Residents and family members are going nuts.”

“Care facilities are ground zero in the fight against the coronavirus, representing a shockingly high share of deaths,” Bill Sweeney, AARP senior vice president for government affairs, was quoted as saying in an article about transparency on the organization’s website. “Even more terrifying is that we are fighting this fight without the facts.”

Sweeney noted that the federal Centers for Disease Control and Prevention are requiring nursing homes to report coronavirus cases to it within 24 hours. CDC has not yet made that reporting public and it is not yet clear whether it will contain total cases and deaths by facility.

Without a way to follow the outcomes of large nursing home outbreaks, it’s difficult for the public to determine how well the virus has been controlled among vulnerable nursing home populations.

Geriatrician Dr. Mehrdad Ayati who teaches medicine at Stanford and works regularly with senior care facilities, said that anecdotally, he’s not seeing the huge spikes in COVID-19 cases in the Bay Area community that were making news in previous weeks. But without comprehensive data, it’s hard to tell.

“We’re just really not sure about that,” he said. And if skilled nursing homes or assisted living facilities aren’t sure of whether patients die after they are transferred out of the facility, the number could be much higher. And because universal testing isn’t mandated across senior care homes, the number of people infected is likely being undercounted as well.

The state data appears flawed in other ways. For instance, the snapshot of cases on Wednesday showed no cases among patients or staff at Orinda Care Center — where five patients have died and a total of 58 infections were report two weeks ago. By Thursday, the numbers were back up: 31 patients and between one and 10 employees tested positive for the virus.

Folmer did not respond to specific questions about the Orinda Care Center. But Contra Costa County Supervisor John Gioia said county health officials told him during a call Wednesday that Orinda Care Center still had a “red” status, meaning the outbreak remains active and is of high concern to local health officials.