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The screengrab above is from the Kaiser Family Foundation (KFF) website tracking COVID-19 nationally — both disease information and public policy responses. A larger image is available here. In order to know what the slide purports to tell us, this data must be being collected and reported, right? Note that data (to put it politely) is “incomplete” — death data for long-term care facilities is only disaggregated from other COVID-19 deaths in 35 of the 50 states. KFF draws its numbers from “available state reports, press releases, press conferences, and official state data from news reports.” Further,
Data as of May 14th, 2020
All available LTC facility data reported by state is presented. Cumulative data is presented, where available. Number of cases is reported for residents and staff, where available. Definition of “long-term care facility” differs by state, but data reflect a combination of nursing facilities, residential care communities, adult care centers, intermediate care facilties, and/or other long-term care facilities. Given the rapidly developing situation and states reporting new data every day, updated data may be available.
*Vermont officials have reported that 50% of deaths in state are in LTC facilities, but did not release raw data.
So the data is incomplete, but is it even accurate? (Well, “accurate” to the same extent all reported COVID-19 deaths are accurate.) Let’s take a look at California. They published a Skilled Nursing Facilities COVID-19 report. The most current report has the following preface:
Data collection is undergoing a transition during the weeks of May 10, 2020 and May 17, 2020 as CDPH enhances its data collection process to improve accuracy, timeliness, and to align with new guidance from the federal Center for Medicare & Medicaid Services (CMS). CDPH guidance for the new reporting process is in All Facilities Letter 20-43.2.
The May 19, 2020 data below is the first report under the new reporting system.
NOTE: The cumulative data under the new reporting system includes cases from January 1, 2020 through May 19, 2020.
NOTE: The data for healthcare worker COVID-19 positive cases and deaths is being validated, and will be included in subsequent data reports.
In the reporting period ending May 19, 2020, 94% of skilled nursing facilities (SNFs) in California reported data to the California Department of Public Health.
As of May 19, the data below is both a point-in-time snapshot of SNFs in California that have reported one or more confirmed COVID-19 cases within the previous 24 hours, as well as a cumulative total since January 1, 2020. SNFs that did not report daily data are listed as “N/A.”
Case numbers are provisional and may change as facilities correct or add data. Values of less than eleven (11) are masked (shown as <11) in accordance with de-identification guidelines. [emphasis added]
COVID-19 fatalities in the chart below include deaths that were reported by facilities to the best of their knowledge. These include deaths that occurred at nursing homes and those that occurred in other locations, such as a hospital or private home, if the death occurred within the 14-day bed hold period after the resident transferred from the SNF. Deaths that occurred outside of this 14-day period may not be captured. Some of these deaths may include residents who had COVID-19, but died of something else.
Given these complexities, fatality totals may not exactly match other data sources or, in some instances, the death may be double counted in more than one data source such as county-level fatality totals.
All data in this chart is provided to offer a snapshot of COVID-19 in skilled nursing facilities in California, and does not imply wrongdoing on the part of the facility.
Based on the reporting date, this report includes fatalities not included in the KFF data referenced above. According to this latest California report, a total of 1,434 SNF residents have died of COVID-19. That is 41% of the reported 3,512 deaths reported statewide as of May 19. That is consistent with the KFF graph showing California as among the 15 states with LTC deaths being 25-49% of their totals. But also note that KFF acknowledges that LTC does not have a common definition between states. What are the characteristics of a facility that should be uniquely identified for particularized infection protocols?
According to an April 28 report in the Sacramento Bee with the headline “At least 40 percent of COVID-19 deaths in California are from eldercare homes, state reveals”:
Residents of long-term care homes in California make up nearly 40 percent of the COVID-19 deaths in the state, new public health data shows, making skilled nursing and assisted living facilities by far the deadliest hotspots in the coronavirus pandemic.
At least 578 nursing home residents in California have died of complications caused by the new coronavirus, according to state health department data quietly published over the weekend and updated Tuesday — representing approximately one-third of all confirmed COVID-19 deaths in the state.
This is the first time California officials have released any numbers about deaths at nursing homes from COVID-19. The numbers could be higher because the current ones only include those “known by the facility” and might not include deaths that occurred after a resident was transferred to a hospital or private home.
By Friday, at least 144 residents in California assisted living facilities, which cater to the elderly but do not provide the same level of medical care as nursing homes, had died of COVID-19 complications, according to the most recent report from the California Department of Social Services[*].
[* The current reporting (as of 5/19/20) is 284 deaths in Residential Care Facilities for the Elderly (RCFE) and some unspecified number in Adult Residential Facilities (ARF) because “there were no facilities with at least eleven (11) COVID-19 positive cases or deaths.” So how many facilities had between 1-10 deaths but those deaths are not identified as being associated with LTC?]
When you combine SNF, RECFE, and ARF deaths for California, the percentage of COVID-19 deaths for all of California represented by elder care facilities is at least 49%. So by focusing on infection control in “elder care facilities,” you can cut your risk for total deaths in the state by half. Seems like this would not only be a priority but, if publicized and emphasized, it would help shift people’s perception of their own risk and facilitate return to normal economic life.
The KFF chart suggests that for at least two-thirds of the states 25% of COVID-19 deaths occur amongst residents of LTCs. That fairly begs for attention and emphasis when discrete concentrations of people like this can be identified. But that is not happening when they are simply part of a presumed larger grouping of the “most vulnerable.” Gathering and collecting consistent information about disease and death in residences with concentrations of elderly would seem an important strategy for refining our public health response. Not doing so transparently and effectively makes the governmental response to feel more like it is about population and economic control than disease prevention and healing.
[Note: Links to all my COVID-19 posts can be found here.]Published in