Day 122: COVID-19 Why Are States Obscuring the Data? Part 2

 

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.]

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  1. DonG (skeptic) Coolidge
    DonG (skeptic)
    @DonG

    Buckpasser (View Comment):
    The data is being obscured to make sure we remain under house arrest for as long as possible. I will venture to say that there have been more deaths of people over 80 years old than all the deaths of people age 0 to 65.

    I like the cynical take you got there.  I assume there are many lawyers that will be sorting this out as they sue states and facilities over the next few years.  I heard today that half the deaths are by people over 80 and half for under, so you ventured well. 

    • #31
  2. MarciN Member
    MarciN
    @MarciN
    • #32
  3. Hammer, The Inactive
    Hammer, The
    @RyanM

    Another data point that I’ve never seen discussed: how many full basketball teams were tested back in March? Pretty sure those percentages were similar to, or even less than, diamond princess. You’d think that conditions on a basketball court and in a locker room would be perfect for transmission, especially if asymptomatic spread is real. But I have not heard discussion of this.

    Again, when we talk about herd immunity, it isn’t just about math… About hitting that percentage of the population. It is about hitting some unknown percentage of the susceptible population, such that the virus effectively dies out.

    I think that will look a lot different than what we have been hearing.

    • #33
  4. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    I think you can confidently add Arizona to states with 50-74% of deaths of long-term care residents.  Though AZ does not report such deaths at the state level, Maricopa County, with 60% of the state’s population does.  In Maricopa 258 of 357 deaths (72%) have been in long-term care (in addition, 2 staff at these facilities have died).  AZ reports 775 total covid deaths.  If only 31% of the deaths elsewhere in the state are associated with long-term care, the state would have 50% of its deaths in that category.

    • #34
  5. Mark Wilson Inactive
    Mark Wilson
    @MarkWilson

    Sorry for the non-substantive comment.  I just hate those kind of pseudo-maps.  They mangle geography and show the relative positions of states wrong, putting states in ridiculous relative positions (Wisconsin to the north of Minnesota?) and bordering states they don’t border.

    • #35
  6. Hammer, The Inactive
    Hammer, The
    @RyanM

    All this argument we’ve been having about masks…

    The county just to the north of mine, with zero fatalities and 62 cases, just issued a requirement that everyone wear masks outside their homes.

    It starts with suggestions, then social pressure, then it becomes law.

    And that is the problem I have with this sort of thing. These are illegal mandates based on pseudo-science and media-driven fear, and they are backed with the threat of force.

    If it saved one life, it would not be worth living in a police state. Nor 10 lives, nor 10,000, not 100,000.

    • #36
  7. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Hammer, The (View Comment):

    All this argument we’ve been having about masks…

    The county just to the north of mine, with zero fatalities and 62 cases, just issued a requirement that everyone wear masks outside their homes.

    It starts with suggestions, then social pressure, then it becomes law.

    And that is the problem I have with this sort of thing. These are illegal mandates based on pseudo-science and media-driven fear, and they are backed with the threat of force.

    If it saved one life, it would not be worth living in a police state. Nor 10 lives, nor 10,000, not 100,000.

    This is a requirement for anytime you leave the house?  Even you are going out for a walk?

    • #37
  8. Old Bathos Member
    Old Bathos
    @OldBathos

    Gumby Mark (R-Meth Lab of Demo&hellip; (View Comment):

    Hammer, The (View Comment):

    All this argument we’ve been having about masks…

    The county just to the north of mine, with zero fatalities and 62 cases, just issued a requirement that everyone wear masks outside their homes.

    It starts with suggestions, then social pressure, then it becomes law.

    And that is the problem I have with this sort of thing. These are illegal mandates based on pseudo-science and media-driven fear, and they are backed with the threat of force.

    If it saved one life, it would not be worth living in a police state. Nor 10 lives, nor 10,000, not 100,000.

    This is a requirement for anytime you leave the house? Even you are going out for a walk?

    If you keep a small Obama statue in a pocket or say “Hope and Change”  three times, the virus can’t infect you. That has the same value as wearing a mask in sunlight.

    • #38
  9. MarciN Member
    MarciN
    @MarciN

    I’ve been thinking about this today. I see a huge problem getting the right and left political sides together. Unless we figure this out, we will not be able to reopen the economy and live normally again. The left is digging in their heels. This is not good.

    We have been embroiled in the climate-warming-colding-change argument for nearly two decades now. And one result has been this very strange attitude on the left that has developed that the right is anti-science. It has become a mantra and a joke on the left that we on the right reject all science. It’s a joke and a meme to them: “You know, science.”

    The attitude on the left toward us has become a serious problem in dealing with the virus.

    • #39
  10. Hammer, The Inactive
    Hammer, The
    @RyanM

    Gumby Mark (R-Meth Lab of Demo&hellip; (View Comment):

    Hammer, The (View Comment):

    All this argument we’ve been having about masks…

    The county just to the north of mine, with zero fatalities and 62 cases, just issued a requirement that everyone wear masks outside their homes.

    It starts with suggestions, then social pressure, then it becomes law.

    And that is the problem I have with this sort of thing. These are illegal mandates based on pseudo-science and media-driven fear, and they are backed with the threat of force.

    If it saved one life, it would not be worth living in a police state. Nor 10 lives, nor 10,000, not 100,000.

    This is a requirement for anytime you leave the house? Even you are going out for a walk?

    “Out in public,” which I imagine is interpreted in many different ways. I’ll dare them to fine me if that mandate comes to my town.

    • #40
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