Nursing home coronavirus infections — and ultimately, fatalities — in New York State were mainly the result of transmission by the facilities’ workforce, according to an analysis done by the New York State Department of Health.
In a report released Monday, the DOH concludes that infections among nursing home staff and transmission of the virus from staff to residents played the predominant role in the spread of the virus and fatalities among nursing home residents — not hospital admissions.
The state agency, which regulates long-term care facilities in New York, has come under fire for a directive it issued on March 25 requiring nursing homes to admit COVID-positive patients discharged from hospitals.
One in four of the state’s approximately 158,000 nursing home workers were infected with COVID-19 between March and early June 2020, according to the report. Nearly 7,000 infected workers were working in New York’s 613 long-term care facilities during the month of March, the report says. During the same period, more than one-third of the state’s long-term care facilities had residents ill with the virus, the report says.
The peak of infections in the nursing home workforce corresponds with the peak of fatalities, occurring, on average, 18-25 days after infection, according to the health department.
Roughly 20,000 infected nursing home workers were known to be COVID-positive by the end of the month of April, according to data presented in the report.
“Nursing home admissions from hospitals were not a driver of nursing home infections or fatalities,” the report said.
“Most patients admitted to nursing homes from hospitals were no longer contagious when admitted and therefore were not a source of infection,” according to the report.
“Health experts believe that individuals infected with the virus are most infectious 2 days before symptoms appear,” the report says. “Preliminary data show that residents were admitted to nursing homes a median of 9 days after hospital admission…” when and “they are likely no longer infectious.”
Nursing home fatalities peaked on April 8, according to the DOH report. Since the average tine from infection to death, according to the DOH analysis is 18-25 days, “it is likely that thousands of employees infected in mid-March could have unknowingly — through no fault of their own — transmitted the virus while working,” according to the report.
Statewide, 310 nursing homes admitted 6,326 COVID-19 patients discharged from hospitals between March 25 — the date of the DOH directive — and May 8. Of those 310 facilities, 252 already had a suspected or confirmed COVID-positive resident, COVID-related confirmed or presumed fatality, or worker-infected prior to admission of a single COVID-positive patient.
This means “the admission of a COVID patient did not introduce COVID into the nursing home as it was already present,” the health department said.
Moreover, 222 of the state’s nursing homes already had residents with confirmed or suspected COVID-19 prior to the March 25 DOH guidance.
The health department noted that prior to the governor’s March 13 order suspending visitation at all long-term care facilities, “there was no tracking or testing of family and friends who were present in the facility, and any asymptomatic or symptomatic visitor could have been granted access.”
The quality of nursing home care was not a factor in nursing home fatalities, the DOH said in the report.
The New York State Health Facilities Association and the New York State Center for Assisted Living, which represents more than 450 nursing homes and assisted living facilities in New York, said in a statement yesterday that “nursing homes and assisted living facilities were not the top priority” at the onset of the COVID-19 crisis.
“The principal focus of policymakers was on bolstering hospital resources and ramping up hospital bed capacity. This strategy included the Department of Health’s March 25 advisory,” said Stephen Hanse, president and CEO of the nursing home advocacy group.
Hanse called on policymakers and elected officials to provide long-term care facilities with the resources they need to combat the virus and safeguard their residents and staff.
“For too long, nursing homes and assisted living providers have been subjected to significant Medicaid cuts. These cuts must stop,” Hanse said.
First Congressional District Rep. Lee Zeldin (R-Shirley) has called for an investigation by the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services into New York State’s handling of the COVID crisis with respect to nursing homes and long-term care facilities.
“An internal review by the State of New York is OK for them to initiate, but this is not a situation where it is going to be able to objectively investigate itself,” Zeldin said Monday evening.
“These facilities should not have been required to accept patients who were diagnosed at the time with coronavirus, especially if they did not have the ability to protect the rest of their vulnerable population,” Zeldin said.
“It was also a fatal policy to prevent nursing homes from administering coronavirus tests to patients returning from hospitalization,” he said. “Our seniors and their families deserve answers, and an independent investigation is clearly necessary.”
As of July 5, there were 822 deaths in Suffolk’s 53 nursing home and assisted living facilities. Statewide, as of July 5, there were 6,458 confirmed and presumed COVID-19 deaths in nursing homes and assisted living facilities. Eighty-one percent of those deaths — 5,223 — were in the downstate counties of New York City, Long Island and Westchester, the epicenter of the outbreak in New York State this spring. Suffolk’s long-term care death toll is the third-highest in the state, behind Queens (953) and Kings (834) counties in NYC.
The DOH report cites a New York Times analysis of nursing home COVID-19 fatalities across the U.S. by the, which found that New York’s nursing home fatalities as a percentage of total COVID fatalities (21%) was among the lowest in the nation. On a per capita basis, New York ranked 46th in the country, meaning 45 states had a higher per-capita COVID death toll among nursing home residents.
In raw numbers, though, New York’s nursing home deaths total (which stood at 6,432 as of the June 26 date of the Times’ analysis) was the second-highest in the U.S., which then had a total of more than 54,000 nursing home fatalities.
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