In a new study, researchers found that long-term care facilities (LTCFs) are a major driver of total COVID-19 deaths.
The research was conducted by a team at Boston Medical Center (BMC) and Boston University School of Medicine (BUSM).
The team studied the past month’s case and death data reported by the Massachusetts Department of Health’s COVID-19 daily Dashboard along with data provided by the Kaiser Family Foundation and other countries.
As the pandemic drags on, the proportion of COVID-19 deaths in Massachusetts that occur in LTCFs (nursing homes and group homes) has climbed from 54% to 63% as of May 29t.
The team found some states have even higher proportions of COVID-19 deaths in LTCFs.
According to Kaiser Family Foundation data, as of May 28, 81% of COVID-19 deaths in Minnesota and Rhode Island had occurred in nursing homes.
In Connecticut, the proportion was 71% and in New Hampshire, it was 70%. Another 22 states reported that 50% or more of their COVID-19 deaths occurred in LTCFs.
Despite these lopsided figures, 11 states (Alabama, Alaska, Arizona, Arkansas, Hawaii, Michigan, Missouri, Montana, New Mexico, North and South Dakota) continue to not report the number of COVID-19 deaths occurring in LTCFs, which has contributed to a vast underestimation of the total number of COVID-19 deaths in the United States.
Other causes of under-reporting nursing home COVID-19 deaths include incomplete data collection by states and that up through mid-April, many states and the Centers for Disease Control did not accept a diagnosis of COVID-19 without substantiation by a positive test.
Thus, many deaths were not reported because tests for COVID-19 were largely unavailable to nursing homes.
Now, officials are going back to see if many deaths can be categorized as probable COVID-19 based upon the medical presentation and history of exposure.
As of May 28, New York reported the lowest proportion of COVID-19 deaths in LTCFs at 21 percent, yet the rate is three-four times higher in other Northeastern states.
The team says once they get accurate counts of the COVID-19 deaths in all states, they will likely see a big increase in the total number of deaths in the United States.
Other countries are reporting that the majority of their COVID-19 deaths are also occurring in LTCFs.
In early May, Canada indicated that 82% of its deaths are in LTCFs. The World Health Organization estimates that half of all COVID-19 deaths in Europe and the Baltics happen in nursing and care homes.
However, there are other countries and regions that are bucking the trend.
Hong Kong reports no LTCF COVID-19 deaths and South Korea and Singapore each report fewer than 20 such deaths.
New Zealand, because it closed its borders early and with its strict quarantining policy, also reports fewer than 20 LTCF COVID-19 deaths.
So why are most LTCFs so vulnerable to COVID-19? In Massachusetts, almost 90 percent of LTCFs have had at least one COVID-19 case.
The team says the asymptomatic spread of this virus allows it to easily sneak into these facilities where the essential staff goes from nursing home to nursing home, like X-ray technicians, phlebotomists, nurses, and nursing assistants who have to work more than one job to make ends meet.
Checking temperatures of visitors and staff is obviously not enough. Everyone visiting or working in an LTCF needs to either be found to have immunity to the virus or to be regularly tested.
One author of the study is Thomas Perls, MD, professor of medicine at BUSM.
The study is published in the Journal of the American Geriatrics Society.
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