In this cross-sectional study of more than 15,000 U.S. nursing homes, approximately 44% of COVID-19 cases and 40% of COVID-19 deaths that occurred before the start of reporting weren't reported in the first National Healthcare Safety Network (NHSN) submission in sample states, suggesting there were more than 68,000 unreported cases and 16,000 unreported deaths nationally.

Shen, et al. (2021) state that federal data underestimate the impact of COVID-19 on U.S. nursing homes because federal reporting guidelines did not require facilities to report case and death data until the week ending May 24, 2020.

Among 15,415 US nursing homes, including 4,599 with state case data and 7,405 with state death data, a mean (SE) of 43.7% (1.4%) of COVID-19 cases and 40.0% (1.1%) of COVID-19 deaths prior to May 24 were not reported in the first NHSN submission in sample states, suggesting that 68 613 cases and 16 623 deaths were omitted nationwide, representing 11.6% of COVID-19 cases and 14.0% of COVID-19 deaths among nursing home residents in 2020.

These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks.

Reference: Shen K, et al. Estimates of COVID-19 Cases and Deaths Among Nursing Home Residents Not Reported in Federal Data. JAMA Netw Open. 2021;4(9):e2122885. doi:10.1001/jamanetworkopen.2021.22885