N.Y. Health Officials: Data Shows Staff, Not Resident Admissions, Drove COVID-19 in Nursing Homes

Citing the timeline of infection and death rates at nursing homes, health officials in New York on Monday asserted that asymptomatic staffers were a primary driver of COVID-19 cases in long-term care facilities — and not, as many have suggested, a controversial state mandate requiring nursing homes to accept positive patients.

The New York State Department of Health (NYSDOH) analysis primarily focused on the time lags between peak resident deaths in nursing homes and the leading indicators of resident and staff infection rates.

Many of the conclusions were predicated on early research indicating that people generally have 18 to 25 days between an initial COVID-19 infection and subsequent death.

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“Therefore, the link between the timing of staff infection and nursing home mortality is supported by the fact that the peak number of nursing home staff reported COVID-19 symptoms on March 16, 2020 — 23 days prior to the date of the peak nursing home fatalities, which occurred on April 8, 2020,” the report concluded. “It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection.”

New York Gov. Andrew Cuomo ordered mandatory twice-per-week testing of nursing home staffers on May 20; the subsequent data revealed that about a quarter of the Empire State’s 158,000 nursing home employees were COVID-19 positive between March and June.

Conversely, the NYSDOH asserted that the timelines absolve from blame the state’s requirement that nursing home operators could not deny admission based on a positive COVID-19 test.

“Nursing home resident fatalities peaked on April 8, 2020. The peak of nursing home admissions from hospitals did not occur until April 14, 2020, a week after peak nursing home fatalities — suggesting the policy was not the cause,” the report concluded.

Between March 25 and May 8, 310 nursing facilities accepted more than 6,300 COVID-positive residents from hospitals — 252 of which already had suspected or confirmed cases, according to the report.

The discussion of mandatory admissions has become a key partisan football as lawmakers seek to sort out what went wrong during the peak of the COVID-19 crisis in nursing homes.

Cuomo has repeatedly asserted that his state was following federal guidelines with all of its nursing home policies; Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma has replied that Washington never recommended sending positive patients to nursing homes.

The Democratic-led investigations into the crisis have focused on CMS and individual operators, while Congressional Republicans have zeroed in on Cuomo and other governors, all Democrats, whose states had similar orders.

The NYSDOH is part of the state’s executive branch under Cuomo; the governor appointed its commissioner, Howard Zucker, in 2015.

The report also seemed to back up earlier research showing no connection between a nursing home’s quality rating and COVID-19 outcomes: In fact, nursing homes with the top five-star rating from the federal government had a higher mortality rate (12%) than those with the worst one-star rating (7%).

The state’s explanation also mirrors emerging research indicating that the intensity of the spread in a community has a straight-line impact on the likelihood of outbreaks in nursing facilities. According to the NYSDOH analysis, 80% of staff members that tested positive for the virus were from the areas of the state most affected by the coronavirus generally: New York City, Long Island, and the Hudson Valley.

“From the data, the apparent explanation for this phenomenon is that the geographic location of the nursing home facility, and its corresponding rate of community infection, had a greater connection than the performance of the nursing home facility,” the NYSDOH observed. “Data show the predominance of nursing home deaths were in downstate New York and unrelated to the performance of the particular nursing home.”