New Weekly Nursing Home COVID-19 Case Count Hits Record High

The number of new COVID-19 cases in nursing homes reported to the federal government at the end of July surpassed its previous high-water mark back in May, a new analysis from a leading trade group determined.

The nation’s nursing facilities reported 9,715 confirmed COVID-19 infections during the week ended July 26, the American Health Care Association determined — an increase of more than 4,000 from a previous low of 5,480 observed toward the end of June.

The July 26 figure also exceeded the previous high of 9,421 new weekly cases logged at the end of May.

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The organization, which represents for-profit nursing facilities across the country, placed the blame on high community spread of COVID-19 in the Sun Belt states, along with persistent problems in securing sufficient access to testing and personal protective equipment (PPE).

Source: American Health Care Association

Of the confirmed cases reported in the July 26 round of data, 7,550 came from the Sun Belt, representing 78% of the national total, according to the AHCA analysis. The region accounted for 32% of the total during the last week of May.

“With the recent major spikes of COVID cases in many states across the country, we were very concerned this trend would lead to an increase in cases in nursing homes and unfortunately it has,” AHCA CEO Mark Parkinson said in a statement. “This is especially troubling since many nursing homes and other long-term care facilities are still unable to acquire the personal protective equipment and testing they need to fully combat this virus.”

Since May, nursing homes have been required to report a range of COVID-19 data to the National Healthcare Safety Network (NHSN), a database maintained by the Centers for Disease Control & Prevention (CDC).

Nearly 46,000 people died of COVID-19 in nursing homes through August 2, the most recent week for which the NHSN data was available. More than 177,000 cases in the setting have been confirmed, along with about 109,000 suspected infections. The true numbers are almost certainly higher given the federal government’s inability to mandate retroactive reporting of cases prior to the creation of the database in May.

Multiple studies have found a strong connection between community spread and the likelihood of outbreaks in nursing facilities. Sufficient staffing levels are also a key factor in the extent of COVID-19 infections at nursing homes, though a team from the University of Chicago recently determined that overall case counts in a surrounding area remain the strongest predictor of the effects at nursing homes.

“While potentially meaningful, these effects are dwarfed by the effect of where the virus is circulating,” the UChicago researchers wrote of staffing differences. “The largest magnitude effects we find are for county metropolitan status and county-level number of COVID-19 cases per capita that occur among the general population.”

AHCA used the statistics to argue for increased relief funding for nursing homes and assisted living facilities; AHCA has lobbied for an additional $100 billion on top of the billions already set aside for skilled nursing facilities.

The data came a few days after Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma told nursing home leaders that the agency is “deeply concerned” about the rising number of cases in the space.

In particular, Verma blamed persistent infection control problems at facilities for the trend.

“This is not just a testing issue or a supply issue, and our deep concern is that even in nursing homes that are doing testing on a regular basis, that we are still seeing significant spread — and so even with our commitment to do more testing, to ensure you have the supplies that you need, our concern is that that’s not going to necessarily completely address the problem,” Verma said on August 13.

CMS the following day announced that it has handed down $15 million in fines since the start of the pandemic, while tripling the number of infection control citations issued. The total includes about $10 million associated with infection-related citations, and $5 million in penalties for operators that failed to report their COVID-19 data to CMS and the CDC as required.

The federal government has faced criticism from resident advocates who have claimed that the relatively low numbers of infection control problems cited in nursing homes during the pandemic could not accurately reflect the situation on the ground given the high numbers of infections and deaths.

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