Spread of COVID-19 in nursing homes started by staff members, DOH report says

The spread of COVID-19 in New York’s nursing homes — resulting in about 21% of the state’s 24,913 fatalities — was unknowingly driven by asymptomatic employees entering the facilities at the beginning of the pandemic, according to a report released Monday by the New York State Department of Health.

A congregate setting like nursing homes and their largely elderly population proved to a deadly mix. Limited testing and an initial belief that asymptomatic patients could not transmit the virus contributed to an early surge of cases.

The “in-depth analysis” found that nearly 37,500 nursing home staff members — about 25% of the statewide total — were infected with COVID-19 between March and early June. Nearly 7,000 of those staff members were working at facilities in March.

Gov. Andrew Cuomo has faced criticism for a March 25 guidance that said nursing homes could not discriminate against COVID-19 patients and deny a nursing home resident after a hospital stay. At the time, the governor argued that hospitals needed space to accommodate the influx of COVID-19 patients, and thus couldn’t keep nursing home patients until they tested negative.

The data in the report showed that COVID-19 patients released from hospitals back into nursing homes did not lead to a spike in the virus spreading and higher mortality rates. Those patients were largely no longer contagious by the time they returned to the nursing home facilities, the report said.

Mr. Cuomo said Monday that it was a “political conspiracy theory” to claim that deaths in nursing homes could have been prevented.

The Health Department analyzed the timing of COVID-19-positive staff infections and the timing of nursing home deaths. The average length of time between COVID-19 infection and death is between 18-25 days, the report said. The peak number of nursing home staff reported COVID-19 symptoms on March 16, 23 days prior to the date of the peak number of nursing home fatalities on April 8.

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

The report found that the peak date that COVID-19 positive residents entered nursing homes was April 14, a week after peak mortality in New York’s nursing homes.

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

There have 548 confirmed COVID-19 fatalities at Suffolk County nursing homes and another 228 deaths presumed to be caused by COVID-19. In addition, there have been 32 confirmed deaths at assisted living facilities and another 13 presumed coronavirus deaths.

There were more than 420 deaths at Suffolk nursing homes and adult care facilities reported by the end of April.

Peconic Landing in Greenport was one of the earliest known nursing home facilities in the state with positive COVID-19 employees and residents in March. A total of 41 team members out of 377 at the lifecare and retirement community ultimately tested positive for the virus and 13 residents died. Six of those fatalities were reported to the state as part of the facility’s nursing home and another three were listed as presumed. A per diem employee at Peconic Landing was the first positive case reported at the facility March 10.

Acadia Center for Nursing and Rehabilitation in Riverhead reported 15 COVID-19 fatalities and one presumed. No fatalities were reported at San Simeon by the Sound in Greenport.

Melissa DeRosa, secretary to the governor, said a policy shift in May directed hospitals to no longer release nursing home patients until they tested negative twice.

“At that point, there wasn’t as much stress on the hospitals because the number of hospitalizations and beds went down,” she said Monday. “We still didn’t know then what we know now. And so at that point, it was a recognition that the nursing home population was very vulnerable. There were more beds, so we said out of an abundance of caution, you need to test negative to be released.”

Visitation at nursing homes was restricted March 13, just under two weeks after the first positive case was reported in the state. The first Suffolk County case was reported March 8.

The Health Department’s analysis found that preliminary data shows residents were admitted to nursing homes a median of nine days after hospital admission. Health experts now say a COVID-19 patient is most infectious two days before symptoms appear and are likely no longer infectious nine days after symptom onset.

The Health Department’s analysis considered the impact of visitation on the spread of the virus prior to the March 13 directive. The report said there is a likelihood that COVID-19-positive visitors entered nursing homes, “although there is no specific data to support this assumption, and so ultimately this is inconclusive.”

Michael Dowling, Northwell Health’s CEO, said in a statement that the study confirms what they saw in their facilities around the state and that the virus “quickly spread through asymptomatic carriers into our nursing homes, hospitals, places of worship and other congregate settings.” 

He added: “This study highlighted a critically important fact that the overwhelming majority of hospital patients sent back into nursing homes were not only medically stable, they were no longer contagious, and that 81% of the nursing homes receiving COVID patients from New York’s hospitals already had the virus.”

The report also analyzed whether nursing homes that had lower quality ratings over the past several years had a higher death rate than nursing homes with higher ratings. The analysis found that the mortality rate was higher in five-star rated facilities (12% mortality rate) than lower-rated (7%).

Mr. Cuomo said in hindsight, the Centers for Disease Control and Prevention should have sounded the alarm on the coronavirus last December.

“March 1, it was over,” he said. “There were tens of thousands of people in New York, tens of thousands of infections just waiting to manifest themselves.”

He said ideally, testing of nursing home staff members and health care workers would have started in January.

“Now, that is hundreds of thousands of tests,” he said. “And you had no testing capacity. So you would have needed to know the virus was here and you would have actually had to have testing capacity. Neither of which happened.”