An earlier data note found that weekly deaths and cases in LTCF fell to an all-time low in April 2021, largely due to the high vaccination rates between LTCF residents and staff. Additionally, five states in that previous analysis reported zero deaths per 100,000 state residents in April 2021. This data note examines state-reported LTCF data for 42 states plus Washington DC through the end of June 2021 to examine patterns of COVID-19 cases and deaths among Residents and LTCF staff. While most states report a record number of deaths and LTCF cases, a handful of states have seen an increase in deaths, with 12 states reporting higher cases in June 2021 than in an earlier period. Ongoing monitoring to assess the impact of the Delta variant in long-term care facilities statewide may highlight the effect of this recent wave on LTCFs.
LTCFs include a variety of facilities, including nursing homes, assisted living facilities, and other group care facilities for people with disabilities or older adults. The data in this analysis correspond to the week of June 27.th, 2021. See methods for details.
Deaths from COVID-19 in long-term care facilities
In most states, COVID-19 deaths in LTCF have continued to decline, with 14 states reporting zero or close to zero weekly LTCF deaths per 100,000 state residents in June 2021. In 11 of these states, zero deaths per 100,000 state residents are rounded values representing a very small number of LTCF deaths, while Washington DC, Montana, and Rhode Island reported zero actual LTCF deaths in June 2021. 21 states Additional reported a historic low (but not zero) LTCF death rate in the most recent month of data available for the state (June 2021 for most states and May 2021 for Florida) (Appendix Table 1). Overall, the average weekly number of COVID-19 LTCF deaths per 100,000 state residents was 0.1 in June 2021, a 96% decrease from December 2020 (when average weekly deaths were 1.6 per 100,000). This decrease ranges from 77% in Wisconsin to 100% in six states (California, Connecticut, Washington DC, Massachusetts, Montana, and Tennessee) (Table 1).
However, five states reported an increase in COVID-19 deaths in LTCF compared to a prior period. In June 2021, the average weekly deaths were higher than in previous months in Colorado (April 2021), Georgia (May 2021), New York (September 2020) and Wisconsin (July 2020) (Table 2 of the Appendix). Louisiana reported slightly higher deaths in April 2021 (the most recent month available) compared to October 2020. In all five states, however, LTCF deaths in the most recent month were still substantially lower than their peak.
While LTCF trends largely reflect COVID-19 deaths outside of LTCFs, most states report higher death rates outside of LTCFs. For example, states that reported zero or nearly zero deaths from LTCF still reported deaths outside of long-term care facilities, ranging from 0.2 deaths per 100,000 in California to 1.2 deaths per 100,000 in Michigan (data not shown). Overall, COVID-19 deaths outside of the LTCFs have been reduced by 82%, from 3.5 to 0.6 deaths in the 40 states included in this analysis (Figure 2), a smaller decrease than among the LTCFs. .
COVID-19 cases in long-term care facilities
In the 40 states for which we can trend LTCF cases, The average weekly new cases in LTCF was just 0.5 per 100,000 in June 2021, compared to a peak of 19.7 in December 2020, a decrease of 97%. (Figure 3 and Table 2). 28 states reported a historic low case rate in the most recent month of data available for the state (June 2021 for 27 states and May 2021 for Florida) (Appendix Table 2). Almost all of the states surveyed have experienced a decrease of at least 90% in LTCF cases since December 2020, with Vermont and Washington seeing a decrease of 89%.
However, unlike deaths, only one state (Rhode Island) reported zero LTCF cases per 100,000 state residents, and 12 states reported higher average weekly LTCF cases in June 2021 compared to a previous month. (Table 2 and Table 2 of the Appendix). Three states reported their lowest LTCF case rate in March 2021 (Colorado, Kansas, and Louisiana), six states reported their lowest LTCF case rate in April 2021 (Arkansas, Mississippi, Montana, New Mexico, Utah, and Wisconsin), two states reported their lowest LTCF case rate in May 2021 (Georgia and Nevada), and Vermont reported their lowest case rate in October 2020. Among the 12 states reporting data on new cases among residents and Staff separately, most states reported higher new cases among LTCF staff than LTCF residents (data not shown), likely reflecting the higher proportion of unvaccinated staff at LTCF compared to LTCF residents. It is unknown whether these new cases are among vaccinated or unvaccinated residents and staff, or whether these cases stem from Delta variant infections.
Cases outside of LTCF have been substantially higher than cases in LTCF throughout the pandemic, with some state variations. Cases outside of LTCF have dropped since December 2020, from 390.5 to 26.2 cases, a sharp drop of 93% reflecting the 97% drop in LTCF cases (Figure 3). However, of the six states that reported higher LTCF cases in June 2021 than April 2021 (Arkansas, Mississippi, Montana, New Mexico, Utah, and Wisconsin), only Arkansas reported higher non-LTCF cases in that same year. period of time, suggesting more rapid spread. of the virus in LTCF than the surrounding community in the other 5 states.
Potential impact of the Delta variant
The highly communicable nature of the Delta variant may affect this decreasing trend in LTCF cases and deaths. Preliminary federal data show a slight increase in nursing home cases and deaths nationwide in the first weeks of July 2021. Given the steady decline in LTCF cases and deaths since January 2021, additional weeks of data is needed to understand whether this slight increase is due to an anomaly in the data or the emergence of the Delta variant in the surrounding communities. While current data show that many of the recent hospitalizations and deaths Because COVID-19 is among the unvaccinated, many people in these facilities have pre-existing health conditions that could put them at high risk of illness or death if they experience a breakthrough infection, regardless of vaccination status. Ongoing monitoring and analysis can shed light on the impact of increased community cases, given the close links between community spread and LTCF cases and deaths.
While LTCF cases and deaths have been on a steady downward trend since the launch of the vaccine, there are still several factors preventing the long-term care crisis from coming to an end, including the rise of the Delta variant. and low vaccination rates in some parts of the country. country (both inside and outside of LTCF). These factors will be important to consider as policymakers use the experience of the pandemic in these settings to inform policy progress.
In particular, the high cost that COVID-19 exacted on LTCF staff and residents highlighted the key role that comprehensive, standardized and timely data can play in policy, and the issues that can arise when it does not exist. The federal government implemented a new COVID-19 data reporting system for nursing facilities relatively quickly, but there were still gaps in the data for the first few months of the pandemic, and that data excluded other long-term care settings that also they had high case and death rates. Having robust and comparable data early on could have enabled researchers and policy makers to understand the link between community spread and the spread of the virus in facilities in real time. Additionally, limited data on the characteristics of people in LTCF who became infected or died made it difficult to understand those at higher risk. Going forward, building data systems that can be leveraged during crises to produce accurate, detailed and timely data can be critical in guiding policy responses.
Launching the long-term care partnership to deliver vaccines to residents and staff, while not perfect, had an almost immediate effect that was evident in the data. The Federal Association of Pharmacies distributed almost 8 million doses of the vaccine to LTCF residents and staff from December 2020 to April 2021. Within weeks of the first doses, nursing home cases and deaths decreased, while all other cases and deaths increased. Although the association experienced challenges (including low staff vaccination rates and exclusion from some CTL settings), it ultimately succeeded in vaccinating a high-risk population to reduce overall mortality due to COVID-19. The partnership’s success can provide a blueprint for moving toward successful public-private partnerships and leveraging pre-existing expertise and infrastructure in large-scale public health efforts.
Lastly, the experience of tracking COVID-19 in LTCF highlights the importance of local or specific efforts to understand the data in all states. While the federal government eventually released weekly data on nursing facility cases and deaths that allowed comparison across all 50 states, data anomalies in this data led to efforts, including by KFF, to track data directly from the sites. state websites. Even this effort produced inconsistencies. For example, in March 2021, Wisconsin increased its cumulative long-term care death count by more than 1,000 deaths with no conceivable explanation. A. local news outlet He had already reported this discrepancy and allowed us to understand that this was a data correction and did not reflect what was happening on the ground. This pattern was repeated throughout the pandemic: Many states had a few dedicated reporters and media outlets closely monitoring their individual state’s long-term care data, and more importantly, they had contacts in state departments. suitable. These local media outlets were instrumental in providing insight into data anomalies or state changes that affected data reporting, effectively creating an additional network of data experts for researchers to leverage.