COVID-19 Cases Quadruple Among Nursing Home Residents, Staff as Overall Counts Surge

Coronavirus cases among nursing home residents and staff are surging alongside community numbers in 20 states across the country, a new analysis from the Associated Press and the University of Chicago has determined.

Between May and October, weekly case counts for residents jumped from 1,083 to 4,274, while deaths doubled from 318 to 699 per week; weekly staff infections climbed from 855 in May to 4,050 during the week ended October 25.

The Associated Press commissioned the study, conducted by UChicago researchers Rebecca Gorges and Tamara Konetzka.


“Trying to protect nursing home residents without controlling community spread is a losing battle,” Konetzka told the news agency. “Someone has to care for vulnerable nursing home residents, and those caregivers move in and out of the nursing home daily, providing an easy pathway for the virus to enter.”

The United States set new records for daily COVID-19 infections over the past week, with the figure hitting 100,000 for the first time on November 4, according to data from Johns Hopkins University.

That overarching trend is cause for serious alarm among long-term care residents, employees, and their families. The link between community spread and outbreak risk in nursing homes and other institutional care settings has been known for months now; while staffing support plays a role in curbing the severity of the outbreaks once they occur, community infection rates remain the top predictor of COVID-19 entering a given facility.


Gorges and Koneztka reached that conclusion in a separate study published in August.

“While potentially meaningful, these effects are dwarfed by the effect of where the virus is circulating,” Gorges and Konetzka 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.”

The Centers for Medicare & Medicaid Services (CMS) acknowledged that the effect of COVID-19 on nursing homes is “multifactorial” in a statement provided to the AP, but pushed back on Gorges and Konetzka’s findings that past quality and infection control performance have little to no impact on the likelihood of outbreaks.

“Many times, the likely causes of nursing home outbreaks are simply nursing homes failing to comply with basic infection control rules,” the agency told the AP in a statement.

CMS has identified continuing infection control struggles at nursing homes, even after shifting its inspection process early in the pandemic to focus solely on that domain.

“What we are seeing are significant deficiencies in infection control practices,” CMS administrator Seema Verma said on an August call with nursing home operators. “A lot of your management seems to be very attuned to the requirements and the guidelines. These are long-standing guidelines that we’ve had in place. Unfortunately, what we’re seeing on the ground is that some of the translation to frontline staff — sometimes that there are issues there.”

The AP-UChicago study focused on 20 states that have recently experienced their highest COVID-19 hospitalization rates: Alaska, Arkansas, Iowa, Idaho, Indiana, Kansas, Kentucky, Minnesota, Missouri, Montana, Nebraska, New Mexico, North Dakota, Ohio, Oklahoma, South Dakota, Utah, Wisconsin, West Virginia, and Wyoming.

Across that wide footprint, the researchers found that one in six facilities had not tested workers during the previous week; one in five reported shortages of vital personal protective equipment (PPE), such as masks and gowns; and one in four indicated a shortage of nurses.