Study: Federal reporting of COVID-19 fatalities in nursing homes missed at least 16,000 deaths

Government estimates of the coronavirus deaths in U.S. nursing homes may have missed more than 16,000 COVID-19 deaths, a new study finds.

A peer-reviewed study published Thursday in JAMA Network Open, a publication of the American Medical Association, found that up to 14% of the true COVID-19 death toll in nursing homes was unreported nationally.

Also, researchers estimated that as many as 68,000 coronavirus cases were missed in the federal National Healthcare Safety Network reporting system because the government did not require reporting until late May 2020.

The study arrived at its findings by comparing COVID-19 cases and deaths reported by U.S. nursing homes to the NHSN with those reported to 20 state departments of health in late May 2020. This comparison found that 4 in 10 COVID-19 deaths that occurred before the federal government implemented reporting requirements were never reported.

"These findings suggest that federal NHSN data understate total COVID-19 cases and deaths in nursing homes and that using these data without accounting for this issue may result in misleading conclusions about the determinants of nursing home outbreaks," the researchers wrote.

Extrapolating for the nation, the study suggests there were as many as 592,629 COVID-19 cases and 118,335 related deaths in nursing homes by the end of 2020.

"We did not find differences in nonreporting by facility characteristics (i.e., region, ownership, chain affiliation, or star rating) as of May 24," the researchers said. "This implies that facilities of all types omitted previous cases and deaths in the first NHSN submission. This may demonstrate a widespread inability of nursing homes to reliably collect data early in the pandemic or that pressures to report fewer cases and deaths were common to all facilities."

According to the study, there was a "clear regional correlation" in the percentages of cases and deaths that were unreported, with states in the northeast having the highest percentages. This means that delays in reporting affected states like New York most.

"Using the raw NHSN data would imply that similar numbers of nursing home residents died in New York and California in 2020," the researchers explained.

Federal data suggests there were 5 deaths for every 100 beds in New York and 4.8 deaths per 100 beds in California. But after adjusting for the unreported deaths, the researchers estimate there were actually 8.1 deaths per 100 beds in New York compared to 5.5 deaths per 100 beds in California.

The bottom line is that federal reporting of COVID-19 cases and deaths in nursing homes is likely understating the true number of each. It's possible the true number of people who died of COVID-19 in those facilities will never be known.