Why COVID-19 Cases and Deaths Were Significantly Underreported

Early in the pandemic, it was clear that the highest number of COVID-19 cases and deaths occurred in long-term care facilities around the country. The statistics, as shared by the federal National Healthcare Safety Network (NHSN), are grim enough, however, they are also significantly underreported. Nursing homes and other long-term care facilities were not required to report the number of confirmed COVID-19 cases and deaths until May 24, 2020.

PKSD shares findings and conclusions on a study submitted to the Journal of the American Medical Association (JAMA) that further estimates the number of unreported cases and deaths and why this data matters.

The Impact of Infection in Long-Term Care Facilities

Infection outbreaks and difficulty preventing or containing them, are not new issues for long-term care facilities. Elderly residents already have underlying medical conditions, making them more vulnerable to outbreaks and excess deaths brought on by the pandemic. However, that vulnerability of both age and health, when combined with a highly infectious virus, like COVID-19, was further impacted by many other long-time contributing factors, such as staffing shortages and nursing home violations.

One online COVID-19 tracker, which ended on March 7, 2021, reported that approximately one in every 12 residents living in long-term care in the U.S. died from COVID-19.

What the Study Reveals

The study reveals that, nationally, there are an estimated 44.7 percent more COVID-19 cases and 40 percent more deaths that occurred prior to May 24, 2020. Translated into numbers rather than percentages, this data estimates there were an additional 68,000 more unreported cases of COVID-19 and 16,000 more COVID-19 deaths across the country.

Not including estimates provided by this study, there are currently, as reported by the Centers for Medicare and Medicaid Services (CMS), 681,183 COVID-19 cases and 134,908 deaths nationwide.

Facility characteristics (including star rating, ownership, region or chain affiliation) did not yield any differences in data that was not reported.

How Was This Outcome Determined?

The study obtained and compared the number of COVID-19 cases and deaths that facilities reported to their state health departments with the numbers reported to the NHSN in May 2020. The sample data was obtained from nursing homes in 20 states. Of those 20:

• 4,598 long-term care facilities in 12 of the states were required to report confirmed COVID-19 cases
• 7,401 facilities in 19 of the states were required to report confirmed COVID-19 deaths

Estimates of the unreported numbers were then hypothesized using existing nationally unreported cases and deaths for May and December 2020 – 15,397 facilities in all. These data were further analyzed from December 2020 to May 2021.

Why This Information Matters

This study asserts that if only the existing federal data is used, misleading conclusions about the impact of policies (state and/or federal) and facility characteristics on outbreak infection prevention, may result. Using existing federal data in combination with the estimated findings, however, may help us to gain a clearer understanding of the key issues impacting nursing home residents, along with other contributing factors that affect the magnitude of outbreaks in long-term care facilities. This information could help facilities better understand how to prevent outbreaks, contain infection spread, and improve outcomes.