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Under pressure, Maryland to post data on coronavirus at nursing homes, which account for most COVID-19 deaths in some counties

Amid pressure from families, patient advocates and the nursing home industry itself, Maryland said Monday that it will begin releasing data on coronavirus infections and deaths at long-term care facilities this week.

The announcement comes days after state officials denied requests for that information from The Baltimore Sun, and after health officials also refused to share it with the state’s largest nursing home associations. A state health official said disclosing how many cases or deaths have occurred at specific facilities would compromise patients’ right to privacy and serve “no public health purpose.”

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The about-face comes as county health officials revealed to The Sun on Monday that nursing homes and other long-term care facilities account for a significant portion of the 858 COVID-19 deaths reported across the state as of Monday. In Baltimore and Anne Arundel counties, for example, residents of those communities represent two-thirds of deaths confirmed or suspected to be coronavirus-related, county officials said.

Long-term senior care facilities account for 17% of deaths in Prince George’s County, 29% in Baltimore City, 36% in Harford County, 54% in Howard County, 67% in Baltimore County, 71% in Anne Arundel County, and more than 90% in Carroll County, where more than two dozen people have died in an outbreak at a single Mount Airy nursing home. Officials in Montgomery County did not respond to similar requests Monday.

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Baltimore officials had said Monday that nursing home residents account for 20% of the city’s coronavirus deaths, but data posted on a city website Tuesday showed the rate to be higher.

In announcing that the state would make the information public after all, Gov. Larry Hogan said in a statement that transparency is “at the heart of our response to COVID-19.”

Maryland is one of 15 states that has not made public detail about the prevalence of coronavirus cases and deaths in elder care facilities, according to data gathered by the Kaiser Family Foundation.

Mike Ricci, a spokesman for Hogan, said that while state health officials had legal reasons for keeping nursing home-level data secret, “given that we are in a crisis, and a fairly extraordinary situation, we are overriding those concerns in the interests of public health.”

Anna Palmisano, director of Marylanders for Patient Rights, said she is glad to see more information released. But she said it’s most important that nursing homes follow guidance from the U.S. Centers for Medicare and Medicaid Services, which has proposed requiring nursing homes to inform residents and their families within 12 hours of a positive coronavirus test at their facility.

“That’s really important so that families and their representatives know,” Palmisano said. “Families are investing a lot of money so their relatives can be safe and the irony is, it’s the opposite that has happened.”

Some nursing home administrators may be “unhappy” with the decision because of concerns the information will cause them to lose staff and residents, said Kevin Heffner, CEO of the LifeSpan Network, an association of nursing homes across Maryland and Washington, D.C.

“Of course we’ll support what the governor is trying to do,” he added.

At the same time, the information will help nursing home leaders who have been asking the state for lists of facilities that have confirmed coronavirus outbreaks because they say they need the information to help contain outbreaks. Many nursing home staff and contractors work in multiple facilities.

Because visitation to nursing homes has been restricted since the pandemic reached Maryland, it is believed outbreaks have largely started with staff members, who in many cases may not be showing symptoms.

A lack of testing for people who aren’t showing typical COVID-19 symptoms has increased that risk, said Morgan Katz, an assistant professor at Johns Hopkins University.

Katz, who has been working with nursing homes on “strike teams” assembled by the state to address nursing home outbreaks, said investigations have backed up concerns about the asymptomatic spread. When she has helped conduct testing of all staff and residents at nursing homes, as many as two-thirds of people who have tested positive were not showing symptoms at the time of their test, Katz said.

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Such broad testing revealed an outbreak of 170 infections, including both residents and staff, at FutureCare Lochearn in Baltimore. But, Katz said, such large outbreaks are likely far more typical than is realized.

“What we found is that in most of these facilities, if they had one or two symptomatic residents, it had spread really throughout the facility and we really weren’t capturing the asymptomatic residents,” she said.

So Katz said she was not surprised to learn that nursing homes are accounting for such a large proportion of deaths in counties such as Anne Arundel and Baltimore.

“We’re seeing these numbers really across the world and across the U.S.,” Katz said. “You have a highly vulnerable [population] in a group living setting. They are going to be at highest risk.”

The information could help direct how resources and other assistance are provided to nursing homes during the pandemic going forward.

Heffner said the nursing home industry is making the case to state health officials that a host of resources, equipment and attention given to hospitals to prepare for an expected surge should be shifted in part to nursing homes.

“How about we take care of the people who are sick now, and figure out, if there is a [hospital] surge, how to manage that then?” Heffner said.

Joe DeMattos, CEO of the Health Facilities Association of Maryland, said the data on nursing home deaths underscores a request his organization and two others sent Hogan last week, asking for a greater emphasis on coronavirus surveillance at nursing homes, regardless of residents’ or staff members’ symptoms, or lack thereof.

“What they really need to do is get serious about testing,” he said.

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