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In Many Areas, Majority of COVID-19 Deaths Occurred in Long Term Care

Many community pharmacies have a close relationship with local long-term care facilities, which have been extremely hard-hit by the COVID-19 outbreak. Most of the nearly 40 states reporting deaths specifically from those locations have had at least 50% of their deaths occur in long term care residents. Find out why a new study said that is likely an undercount, and that those deaths could actually be even higher than realized.

BOSTON – Being on the frontlines of the COVID-19 outbreak didn’t only mean that pharmacies stayed open and continued to supply essential drugs and products to their communities. Many of them also have close working relationships with long-term care facilities, which are arguably the most significant hotspots for novel coronavirus transmission and deaths.

A report in the Journal of the American Geriatrics Society quantifies the data. Boston Medical Center and Boston University School of Medicine geriatricians studied data reported by the Massachusetts Department of Health, as well as that provided by the Kaiser Family Foundation and other countries.

https://onlinelibrary.wiley.com/doi/10.1111/jgs.16669

In Massachusetts, they report, the percentage of COVID-19 deaths in nursing homes and group homes rose from 54% over the course of the pandemic to 63%, as of the end of May. Researchers point out that other states are experiencing even higher proportions of deaths from long term care facilities. Citing Kaiser Family Foundation data, as of May 28, they note that 81% of COVID-19 deaths in Minnesota and Rhode Island had occurred in nursing homes. In Connecticut,  the proportion was 71%, and 70% in New Hampshire.

In fact, according to the article, an additional 22 states reported that half or more of their COVID-19 deaths occurred in those facilities. Yet, 11 states --Alabama, Alaska, Arizona, Arkansas, Hawaii, Michigan, Missouri, Montana, New Mexico, North and South Dakota – still aren’t breaking out the number of COVID-19 deaths occurring in long term care facilities. That probably contributed to a vast underestimation of the total number of COVID-19 deaths in the United States, according to the authors.

Adding to the undercount is that, until mid-April, the national Centers for Disease Control and Prevention did not accept a diagnosis of COVID-19 without substantiation by a positive test. Because COVID-19 tests were largely unavailable to nursing homes, those deaths weren’t counted.

An effort is being made to go back and determine if probable COVID-19 deaths can be added to the total, based upon the medical presentation and history of exposure, the authors write.

As an illustration of the problem, the article notes that, as of May 28, New York reported the lowest proportion of COVID-19 deaths in long term care facilities at 21%, far less than other  Northeastern states. "Once we get accurate counts of the COVID-19 deaths in all states, we will likely see a big increase in the total number of deaths in the United States," explained co-author Thomas Perls, MD, professor of medicine at BUSM.

The study adds that some other countries also are reporting that the majority of their COVID-19 deaths are also occurring in long term care facilities, including Canada, which  indicated that 82% of its deaths are in long term care. The World Health Organization estimates that half of all COVID-19 deaths in Europe and the Baltics happen in nursing and care homes.

Not all countries and areas are in line with those trends, however.  Hong Kong reports no LTC COVID-19 deaths ,and South Korea and Singapore each report fewer than 20 such deaths, according to the article. New Zealand, because it closed its borders early and with its strict quarantining policy, also reports fewer than 20 LTC COVID-19 deaths.

The problem in a state such as Massachusetts, where nearly 90% of long term care facilities reported at least one COVID-19 case, is that "the asymptomatic spread of this virus allows it to easily sneak in to these facilities where essential staff go from nursing home to nursing home, like x-ray technicians, phlebotomists, nurses and nursing assistants who have to work more than one job to make ends meet,” advised co-author Lisa Caruso MD, assistant professor of medicine at BUSM.  "Checking temperatures of visitors and staff is obviously not enough. Everyone visiting or working in a LTCF needs to either be found to have immunity to the virus or to be regularly tested."