Health authorities on Monday presented recent research along with data collected from nursing homes that they said shows that the coronavirus had infected nursing homes far earlier than once believed and that readmitting residents that had been hospitalized for coronavirus did not contribute to a higher fatality rate in those facilities.
The press conference, led by New York health commissioner Dr. Howard Zucker and hospital executives from Mount Sinai Hospital as as Northwell Health, was the most concerted and detailed effort yet to exonerate Governor Andrew Cuomo from nagging criticisms that he failed to do enough to protect the elderly, who early on were identified as the most vulnerable to dying from the disease.
On Monday, Zucker said the state's study was designed to help New York and other states better understand the spread of the virus as well as to "bring closure" to families who have lost relatives to coronavirus at nursing homes.
Citing a recent antibody study by Mount Sinai, Zucker said that new evidence now suggests that the virus was present in New York City as early as February 1st. Given that finding, he said the spread of covid within nursing homes was caused by visitors and employees rather than hospitalized residents.
"It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly—through no fault of their own—while working, which then led to resident infection," the study states.
Epidemiologists and long-term care watchdogs contacted by Gothamist/WNYC largely accepted the data analysis but said that in their push to acquit state leaders, health officials now were “missing a crucial opportunity” to probe deeper problems in nursing homes that accelerated transmission and led to more deaths.
“What will follow this report, and what are the lessons the state has learned?” asked Susan Dooha, executive director of the Center for Independence of the Disabled, New York. “Advocates haven't attributed deaths in facilities primarily to the governor's order or to discharges from hospitals. We’ve expressed concern about lack of sufficient infection control, about lack of inspections by the state, about staffing and very high resident-to-staff ratios. We feel that there's a great deal more to explore and that the state has avoided responding to some of the tough issues.”
Across the U.S., the toll of the coronavirus on nursing home residents and workers has been staggering. Last month, the New York Times reported that 43 percent of all virus deaths in the country were linked to nursing homes. Experts have speculated that both the federal government and states failed to do enough to contain the spread of the virus in congregate settings. In May, the Associated Press reported that over 4,500 recovering coronavirus patients were readmitted into New York nursing homes.
The reason stems from a March 25th directive from the state Department of Health that stated: "No (nursing home) resident shall be denied re-admission or admission to a nursing home solely based on a confirmed or suspected diagnosis of COVID-19."
State officials have staunchly defended the policy, saying it had been intended to free up hospital beds for the sickest patients and was based on federal guidance that nursing homes "should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present."
They have also maintained that no nursing home in the state was required to take in patients they were unequipped to care for.
New York health authorities later reversed the guidance on May 10th.
New York has in fact fared better than most states in nursing home deaths. According to a tally by the Times, New York ranked 46th in the share of deaths linked to long-term care facilities, a statistic that Zucker and others on Monday repeatedly cited.
Compared to other states in the region, including New Jersey and Connecticut and Massachusetts, New York had the fewest coronavirus nursing home deaths per capita, that of 33 per 100,000. New Jersey had 75 for every 100,000, while Massachusetts 74 for every 100,000 people. Connecticut had the most per capita, that of 86 per 100,000 people.
Zucker also pointed out that of the 310 nursing homes who had sent COVID-19 patients to hospitals and later readmitted them, 252 or 81 percent already had infections present prior to patients being readmitted. By mid-May, 37,000, or 24 percent of all nursing home employees in New York had either tested positive or were showing signs of coronavirus infections, he said.
The timing of nursing home deaths and hospitalizations would also seem to support earlier infections. Nursing home deaths in New York state peaked on April 8th, less than a week before hospital admissions for the virus peaked.
On top of that, Zucker said that the median duration of covid-related hospitalizations was nine days, enough time for patients to no longer be considered infectious, according to the Centers for Disease Control and Prevention.
But Dr. Denis Nash, professor of epidemiology at the CUNY Graduate School of Public Health and Health Policy, said that does not mean none of the patients were non-infectious.
“If it’s the median, that means half of them would have been admitted [back to nursing homes] earlier, fewer than nine days after hospital admission,” he said. “It leaves open the possibility that a substantial number of individuals could have been discharged when they were still in the infectious period. I would think that that's worth pointing out.”
The state study also found that the quality of a nursing home did not impact fatality rates. In one of the astonishing revelations, Zucker said the mortality rate was actually higher in 5-star-rated facilities, 12 percent compared in 7 percent for lower-rated ones.
Appearing alongside Zucker, both David Reich, president of Mount Sinai Hospital, and Michael Dowling, CEO of Northwell Health, commended the state's response to the crisis as well as the latest findings on nursing home infections.
Dowling, a former aide to Governor Mario Cuomo who was brought in to help the state coordinate the strategy among hospitals, accused people of "Monday quarterbacking."
Cuomo has frequently suggested that the nursing home criticisms were politically motivated. Asked on Monday about the state Health Department's report, Cuomo said, "Nobody knew what they were talking about for a long time."
The governor blamed the CDC for not alerting the public sooner and establishing widespread testing much earlier than it did. New York state started its own testing program in late February. It reported its first confirmed case on March 1st.
Asked what he would have done differently with nursing homes with the benefit of hindsight, Cuomo said he would have started testing every nursing home employee beginning in January.
"That is hundreds of thousands of tests," he said.
Nash said even with limited testing available in the early months of the year, the state could have developed stronger safeguards to protect workers and, in turn, residents.
“It speaks to the importance of having a plan,” he said. “Much of this could be could have been mitigated if there had been some component of the plan that was focused on trying to keep essential workers safe with personal protective equipment.”
Moreover, the government's work on protecting and ensuring the health of nursing homes is not over, experts said.
Richard Mollot, head of the Long Term Care Community Coalition, called on the federal and state governments to restore nursing home inspections that have been largely suspended during the pandemic, except in cases of “immediate jeopardy," which is often a very high bar.
“A relative maybe speaking to a resident [by phone], and the resident is no longer responsive – they may be dehydrated or depressed and lonely – and that person calls into the nursing home complaint hotline, but they’re told, ‘That sounds like a quality of life issue, and we don't take care of quality of life issues,’” Mollot said. “But this can really be immediate jeopardy. People are really from dying, and we should be sending in people to make sure they’re safe.”
Mollot said that several states, including Maryland, Texas and Florida, have sent ‘strike teams’ of inspectors into nursing homes with coronavirus outbreaks, but New York has not.
“They're going in not only alleviating residents suffering and dangerous situations, but making sure that the provider has put in place practices and they have the staffing and other things to meet the needs of their residents,” he said. “That would go a long way — and it's really irrespective of anything that the feds decide to do.”
