A new report from the state Health Department tries to deflect blame for thousands of coronavirus deaths in the state’s nursing homes—but undermines its own case by withholding data and engaging in tendentious analysis.
Most glaringly, it relies on the Cuomo administration’s low-ball estimate of nursing home deaths, which excludes residents who were transferred to hospitals before passing away. No serious study of the pandemic would start by ignoring what could be thousands of victims.
This is an installment in a special series of #NYCoronavirus chronicles by Empire Center analysts, focused on New York’s state and local policy response to the coronavirus pandemic.
The central thesis of the 33-page report, issued Monday, is that COVID-19 was widespread in homes long before the department’s controversial March 25 order compelling them to accept infected patients for admission.
The department presents fresh data to bolster this argument, including a surprisingly high rate of infections among nursing home employees (one in four) and a surprisingly early date for when the number of sick workers peaked (March 16).
Assuming the accuracy of that information, which is based on reporting by the homes, there is a plausible case that infections dating back to March, unwittingly introduced by staff and possibly visitors, account for the bulk of the spiking death toll in April.
On that basis, the department declares that the March 25 order “could not be the driver of nursing home infections or fatalities,” and that admissions policies “were not a significant factor in nursing home fatalities.”
Even taken at face value, the report’s evidence does not support such sweeping conclusions.
Between March 25 and May 8, the department reveals, 6,326 coronavirus-positive hospital patients were discharged to nursing homes, about 20 percent of which had no previously known infections. At a minimum, it seems likely that those admissions made a bad situation worse. The report does not acknowledge the possibility, let alone quantify the impact.
Here are some other causes for doubt:
- The department says the 23-day lag between the March 16 peak of sick workers and the April 8 peak of resident deaths is consistent with the average time from infection to death of 18 to 25 days. According to the Centers for Disease Control, however, older patients tend to die at the lower end of that range – and the March 25 order came 14 days before the peak.
- The report’s analysis assumes that nursing home deaths peaked on April 8, but that timing is based on the state’s partial count of nursing home deaths. A full count, including residents who died in hospitals, might show that the real peak came later, which would undermine the report’s thesis.
- The report contends that patients discharged to nursing homes were unlikely to infect others because they spent a median of nine days in the hospital and coronavirus seems to stop being contagious after nine days of symptoms. By the definition of “median,” however, half the patients would have left the hospital after fewer than nine days and might still have been contagious.
- The report cites a misleading statistic, drawn from a New York Times analysis, indicating that the number of coronavirus deaths in New York nursing homes, as a percentage of all pandemic deaths in the state, is among the lowest in the U.S. Again, that percentage is based on the state’s undercount of deaths in its nursing homes, which renders it meaningless.
In its eagerness to minimize the impact of the March 25 directive, the report sidesteps important policy questions raised by its own findings. At the time it was issued, for example, state officials still did not know how widespread coronavirus already was in the homes. Was it a wise decision under those circumstances? Should the state issue a similar order during the next pandemic?
Also, how and why did the virus spread so quickly in nursing homes?
The report says infections among nursing home workers “are reflective of the larger geographic impact of the virus’s presence across the state.” Yet it estimates that 24 to 29 percent of workers were infected, which is roughly double the Cuomo administration’s estimated rate for the state as a whole. Did the homes themselves become vectors of infection? Given the fragile people in their care, how can they do a better job of infection control in the future?
Some of Governor Cuomo’s harshest critics have portrayed the March 25 order as the sole or dominant cause of coronavirus deaths in nursing homes, and it’s fair for the Health Department to rebut that argument.
It’s also worth remembering that the order was issued in the heat of a crisis, when officials reasonably feared that hospitals would soon be overwhelmed with critically ill patients. The governor’s best defense is that using hospital beds for otherwise stable nursing home residents, under those circumstances, would have been a waste.
Only in hindsight is it clear that pushing people out of hospitals was not as necessary as officials believed.
Still, it was a risky move. Even if it wasn’t the predominant source of coronavirus in nursing homes, it was likely to make a bad situation worse. At a minimum, a study of the coronavirus pandemic in New York nursing homes should have acknowledged that reality and explored safer alternatives for the next pandemic.
After all, the Health Department’s first duty is to protect the public’s health, not the governor’s reputation.