More than 16,000 COVID-19 deaths and 68,000 cases among nursing home residents nationwide were omitted from federal data after officials made it optional for providers to submit some information during the first months of the pandemic, Harvard researchers have found. 

The omissions resulted in severe underreporting by the National Healthcare Safety Network and could have impacted the federal government response to providers most in need during the first months of the pandemic, researchers say. Their study results were published Thursday morning in JAMA Network Open.

“It stresses the importance of requiring reporting as soon as possible and trying to maintain high data quality standards,” co-author Karen Shen, Ph.D., told McKnight’s Long-Term Care News. “That just really complicated knowing what was going on early in the pandemic, and I think that probably delayed any reactions or mirroring policies that would have been helpful.”

Investigators were able to use state data to estimate the total number of nursing home cases and deaths for 2020 for the study. The missed data represented 11.6% of total COVID-19 cases and 14% of total deaths among nursing home residents in 2020.  

The Centers for Medicare & Medicaid Services in April 2020 announced that nursing homes would be required to report COVID-19 infections directly to the Centers for Disease Control and Prevention through the NHSN. In May, the agency updated the requirement to include COVID-related deaths.

“This has made it very difficult to get an accurate picture of the total impact of COVID on nursing homes, especially for facilities in Northeast states that experienced early outbreaks in the spring of 2020,” said co-author David Grabowski, Ph.D.. 

Grabowski added that by including the unreported cases and deaths to the 2020 totals, investigators now estimate the national 2020 total of nursing home COVID cases was 592,629 and the COVID death count was 118,335. 

Karen Shen, Ph.D.

Shen also explained the findings have enabled researchers to compare different regions and states unlike before. She used the example of New York and California, which had similar COVID nursing home death totals prior to any adjustments (5,776 in New York vs. 5,622 in California.) When adjusted with the correct data, findings revealed nursing homes in New York experienced 9,276 deaths (8.1 deaths per 100 beds), compared with 6,487 in California (5.5 deaths per 100 beds).

“We kind of knew what was happening. If you look at total deaths, we know that they were super high early in the pandemic,” Shen added. “If you looked at the numbers from the NHSN, I think most people knew that they were wrong, but it’s just kind of important to quantify them.”