Upwards of 68,000 COVID-19 cases and 16,000 deaths were not reported to the federal National Healthcare Safety Network (NHSN) during the first few months of the pandemic, a JAMA Network study found, as reporting such numbers was optional up until the end of May.
Reporting was mandated on May 24 of last year, more than three months after the first known outbreak at Life Care Center of Kirkland, Wash. The Centers for Disease Control and Prevention (CDC) and NHSN didn’t require nursing homes to retroactively report cases and deaths prior to May 24.
“This has made it very difficult to get an accurate picture of the total impact of COVID on nursing homes, especially for facilities in Northeast states that experienced early outbreaks in the spring of 2020,” David Grabowski said in an email to SNN. Grabowski is a professor of health care policy at Harvard Medical School and one of five authors involved in the investigation.
Kirkland, for one, reported zero cumulative cases in its first NHSN submission; a March 2020 CDC investigation found the facility experienced 81 cases and 23 deaths among residents.
Researchers suggest the missing data may result in “misleading conclusions” concerning nursing home outbreaks — unreported data during this time would account for 11.6% of cases and 14% of deaths among nursing home residents in 2020.
“The delay in required reporting means that the NHSN data miss a significant period of the pandemic, in which cases and deaths were increasing more rapidly than any other point in 2020 except during the wave in the final months of the year,” researchers stated in the report.
Missing data may inform how certain facility characteristics and state or federal policies play a role in outbreaks, researchers said, although findings indicate facilities of all types did not report cases and deaths prior to May 24.
A “widespread inability” and/or “pressures to report fewer cases and deaths” were common among all nursing homes regardless of region, ownership, chain affiliation or star rating.
“To our knowledge, no previous study has used the available data sources in combination with the federal data to estimate national nursing home COVID-19 cases and deaths,” researchers said in the report. “This study aims to fill that gap.”
The investigation pulled federal data on 15,415 nursing homes, along with 4,599 facilities in 12 states with case data, and 7,405 facilities in 19 states with death data.
