By John Kamp, Christopher Weaver and Anna Wilde Mathews, The Wall Street Journal, August 8 2020
After dropping in June, COVID-19 deaths in nursing homes have begun to rise again, fueled by increases in states including Texas and Florida that saw coronavirus surges in the broader population, according to new federal data.
Nursing homes reported 1,046 deaths in the week ended July 26, the most recent available data show. That marked a 14% increase from the prior week and a 24% increase from the ﬁrst week of July, when the number of weekly nursing home deaths in the federal data hit a low point.
Five months after the virus ﬁrst devastated a nursing home in Kirkland, Wash., the new ﬁndings, in a Wall Street Journal analysis of the federal data, show nursing homes’ defenses remain permeable when the virus takes hold in the communities that surround them. The Journal’s analysis excluded some nursing homes with aberrant data.
Before July, the U.S. had appeared to be making progress in limiting the coronavirus toll in nursing homes. The improvement came amid sharp declines in states with severe, early outbreaks, such as New York and New Jersey, where the number of overall cases has also fallen.
Months ago, outbreaks signaled that the virus could spread inside nursing homes from symptom-free staﬀers, showing the need for personal protective equipment and coronavirus testing to help stem the risk, said Tamara Konetzka, a professor of health-services research at the University of Chicago. “The PPE and the testing have not been implemented in the way that we know would minimize the number of nursing-home deaths in these hot spots,” she said.
The Journal has tallied more than 65,000 COVID-19 deaths linked to American long-term care facilities since the start of the pandemic. That total, drawn from state and local health departments as well as the federal tracking system, includes nursing homes and assisted-living centers. These facilities represent at least 40% of all known deaths from the coronavirus disease nationwide, based on about 161,000 deaths recently tallied by Johns Hopkins University.
The Trump administration is closely watching the nursing-home ﬁndings and oﬀering resources to nursing homes that need them, including protective equipment, teams of experts and a new eﬀort to supply rapid-testing platforms, said Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the federal agency that regulates nursing homes and releases the weekly data on coronavirus in the facilities.
CMS has also said it plans to begin requiring testing of nursing-home staﬀ in states with high rates of positive coronavirus tests, but it hasn’t yet issued the rule to implement the new mandate.
“I think this new uptick is because of the uptick that we were seeing in community spread across the South,” Ms. Verma said, regarding the nursing-home deaths.
Many facilities are still waiting six or seven days to get testing results back, which makes it impossible to ensure infected staﬀers without symptoms aren’t working, said Mark Parkinson, chief executive of the American Health Care Association, which represents nursing homes. The new rapid-testing equipment from the federal government, distributed so far to a limited number of facilities, should help, but federal authorities need to give guidance on how to use it, he said.
Ms. Verma said federal guidance is being developed.
The federal data are focused on nursing homes, which report at least weekly, and oﬀer the broadest gauge of how the virus is aﬀecting those facilities. But the numbers have limitations, including gaps in reporting by some nursing homes and inconsistencies with how data from before late May were reported.
The Journal’s analysis found 228 deaths in Texas nursing homes in the week ending July 26, a 19% increase from the prior week and a 66% rise from two weeks earlier.
Texas Health and Human Services Commission spokeswoman Kelli Weldon said the agency can’t speak to the completeness or accuracy of the CMS data. She said the agency is actively investigating and monitoring all long-term care facilities that have reported at least one positive COVID-19 case. Investigations are focused in particular on infection-control practices, she said.
Nursing-home deaths in Florida started to climb in mid-July and reached 152 deaths in the most recent week, according to the analysis of the federal data. A state health agency in Florida didn’t comment on the Journal’s analysis of federal data. State oﬃcials have previously said they focused closely on nursing homes and put many resources into protecting them.
The Journal’s analysis of the death trends starts with data for the last week of May and includes only information from nursing homes that CMS says repeatedly passed a data quality check. The Journal excluded facilities where the number of COVID-19 deaths in a given week exceeded the number of overall deaths reported for that week, an anomaly that would likely indicate other issues with the data.
One such case involved a nursing home in Indiana that said it didn’t experience or report the dozens of deaths included in the CMS database.
CMS didn’t respond to a request for comment on the Indiana facility.
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