A new Harvard analysis makes the connection between employee neighborhoods and the likelihood of COVID-19 outbreaks within those employees’ facilities.

“If a facility’s average staff is coming from a neighborhood that is pretty dense, has a lot of public transportation use and is less white than average, those factors all contribute to higher numbers of death at the facility,” Karen Shen, study author and Ph.D. candidate at Harvard University’s Department of Economics, told McKnight’s Long-Term Care News on Monday. 

Findings from Shen’s study indicated that nursing home outbreak sizes are “strongly related” to the COVID-19 infection rate within a county and that certain characteristics of neighborhoods where staff live are a “large and significant predictor” of outbreaks at their facilities. Specifically, neighborhoods that were less white, had higher population density and more public transportation use were associated with more deaths per COVID-19 deaths per 100 beds. 

Additionally, the study found that those characteristics had a greater impact on COVID-19 outcomes than facility management and quality variables.  

The investigation, which has yet to be peer reviewed and was posted on the online preprint server medRxiv, analyzed facility-level determinants of COVID-19 outbreaks using nursing home data from 18 states.

Shen explained the characteristics are “much more powerful in explaining differences in death rates within a county than many other facility characteristics (such as nursing home rating), and also than the same characteristics of the nursing home’s own neighborhood.” 

“Early evidence suggests that black and Latino communities have been hit hardest by the pandemic. The fact that the nursing home industry draws staff disproportionately from these communities in general may explain some of the enormous impact of the pandemic on nursing homes,” she wrote. 

Shen added on Monday that the findings underscore the importance of testing and PPE for workers.  

“You can’t really know who might be a potential spreader,” Shen said. 

“Easy access to testing for staff members, frequent testing and policies that support when someone is sick — like saying you should definitely take the day [or] week off rather than come in — and providing staff members with the means to do that, I think those are probably going to be the most important [precautions],” she added. “They are the people who are entering and exiting the facility from the community.” 

Other studies have confirmed that community spread is linked to an increase in COVID-19 cases in that community’s nursing facilities. Guidance from the Centers for Medicare & Medicaid Services bases staff testing on the positivity rate in that community.