Unwitting nursing home workers in New York —  not any specific policy — were the main force that led to COVID-19 fatalities among residents there, a report released by the NY Department of Health has found.

About 37,500 of the state’s 158,000 nursing home workers (one in four) were infected with COVID-19 between March and early June, according to the analysis using self-reported data from nursing homes that was released Monday.

Nearly 7,000 of those employees worked in facilities during March, which was when more than one-third of state nursing homes reported infected residents. 

The average time between a resident contracting COVID-19 to death was 18 to 25 days. The peak number of staff members reported symptoms on March 16, which was 23 days prior to the peak number of nursing home fatalities. 

“It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection,” report authors concluded. 

NY Gov. Andrew Cuomo (D)

The state of New York announced its admission policy, which forced nursing homes to take in COVID-positive residents and was met with strong pushback from the industry, in late March. According to a state survey, more than 6,300 COVID-positive residents were admitted into nursing homes from March 25 and May 8. 

The analysis further added that April 14 was the peak date for when COVID-positive residents entered nursing homes. That was one week after peak mortality was recorded for those facilities in the state.

“A causal link between the admission policy and infections/fatalities would be supported through a direct link in timing between the two, meaning that if admission of patients into nursing homes caused infection — and by extension mortality — the time interval between the admission and mortality curves would be consistent with the expected interval between infection and death,” the report explained. 

“If admissions were driving fatalities, the order of the peak fatalities and peak admissions would have been reversed,” it added.

New York Gov. Andrew Cuomo (D) later reversed the admission policy in May. However, the state’s policy — and similar implemented in other states — has faced extreme criticism, including calls for an investigation, from lawmakers and federal health officials.