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Maryland significantly underreports total coronavirus cases and deaths at nursing homes

The coronavirus outbreak at Pleasant View Nursing Home in Mount Airy, which sickened 126 and killed 29, appeared in state reporting on nursing home outbreaks for two weeks before dropping out for several weeks, only to reappear Wednesday with three cases.
The coronavirus outbreak at Pleasant View Nursing Home in Mount Airy, which sickened 126 and killed 29, appeared in state reporting on nursing home outbreaks for two weeks before dropping out for several weeks, only to reappear Wednesday with three cases. (Amy Davis)

Maryland is significantly underreporting total counts of coronavirus cases and deaths at nursing homes and other elder care facilities, posting data on a public online dashboard that lawmakers, advocates and families assumed to be cumulative but was actually only showing snapshots in time.

Hundreds of cases and casualties are missing from the latest totals released Wednesday, an analysis by The Baltimore Sun has found.

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While a state coronavirus website shows 1,359 people have died as a result of “active” coronavirus outbreaks at such facilities, a Sun review of six weeks of state data found that closer to 1,750 resident and staff deaths have been reported since the pandemic reached the state.

Meanwhile, nearly 2,000 reported infections are missing from the state’s current count of cases among elderly residents and their caregivers. The figure was about 9,600 as of Wednesday, about 300 fewer than a week earlier.

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The Sun’s analysis suggests that the pandemic’s toll may have fallen on the state’s nursing homes and other elder care centers more heavily than previously thought, even as many measures of the pandemic’s intensity in the state begin to wane. The latest data from the state suggests nursing homes and related facilities have accounted for about half of all coronavirus deaths in the state, but the proportion actually appears to approach two thirds.

Maryland officials previously said the counts of nursing home cases and deaths posted on a state website are cumulative, but acknowledged Wednesday that figures are removed from the totals when facilities haven’t reported any positive tests or deaths within the past two weeks.

One patient advocate said that discrepancy could cloud decisions on how best to curtail the pandemic.

“How are we really going to address this problem if we don’t know the extent of it?” said Anna Palmisano, director of Marylanders for Patient Rights.

Leaders in the Democrat-led General Assembly said they have struggled to get detailed answers from Gov. Larry Hogan, a Republican, on efforts to increase testing, obtain protective equipment and otherwise assist nursing homes. Informed of the discrepancy in the case and death counts at the facilities, they said it only compounds their frustrations.

“It makes no sense,” said Del. Shane Pendergrass, a Howard County Democrat. “If you’re recording numbers of cases or deaths reported in the state of Maryland, it should be cumulative.”

The Maryland Department of Health, meanwhile, has been reporting the total number of statewide coronavirus cases and deaths on a cumulative basis, reaching nearly 60,000 and more than 2,700, respectively, as of Wednesday.

The revelation comes as the state is starting to receive the results of universal testing of all staff and residents at about 230 nursing homes across Maryland. Hogan ordered that testing six weeks ago, but all tests were not distributed until late May because of logistical challenges. Those tests were due to be returned to labs by last Friday and state officials have said it could lead to a significant surge in infection diagnoses.

But the latest data on nursing home outbreaks showed declines in cases and deaths Wednesday, mirroring consistent downward trends in coronavirus hospitalizations and other key measures the state is tracking.

For example, the state reported that its latest count of coronavirus deaths associated with elder care facilities is 1,359, including 17 staff members. That was more than two dozen fewer deaths than the state reported a week earlier.

The number of reported infections among the facilities’ residents fell to 6,406, down from nearly 6,700 a week earlier.

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Some discrepancies in the data could be tied to double-counting of cases and deaths. For example, many staff members work in multiple facilities.

Since making nursing home outbreak data public in late April, state health officials have routinely removed some facilities from a public database, saying it’s because the list includes only “active” outbreaks. At times, outbreaks have vanished from the database one week, only to reappear a week or two later with slightly higher totals.

One of the state’s earliest and deadliest outbreaks, at Pleasant View Nursing Home in Mount Airy, fell out of the state’s accounting for nursing homes in mid-May. It had 126 cases between residents and staff, and 29 deaths. But Pleasant View reemerged on the list Wednesday reporting confirmed cases in two staffers and one resident.

However, Maryland Department of Health spokesman Charlie Gischlar said Wednesday that the numbers of cases and deaths reported for any given elder care facility are cumulative. He said the statewide counts of all facilities’ cases and deaths “reflect the sum total of that information for the weekly reporting period." He later added that the “point-in-time” list has “consistently shown both where COVID-19 is present and has provided historical context about the presence of COVID-19 among the facilities listed.”

Gischlar said historic data on coronavirus outbreaks at nursing homes and other congregate living facilities is available on a state open data website, from which The Sun pulled its data.

“To appear on the list, facilities report at least one confirmed case of COVID-19 over the prior 14 days,” he wrote. “Facilities are removed from the list when health officials determine 14 days have passed with no new cases and no tests pending.”

Allison Ciborowski, CEO of LeadingAge Maryland, said the ways elder care facilities have reported data has evolved over time, with local health departments initially gathering it, but more recently the Centers for Disease Control and Prevention requiring reporting from nursing homes across the country. For the past few weeks, facilities also have been reporting it to the Chesapeake Regional Information System for our Patients, an electronic health records database serving Maryland and the District of Columbia.

“I think there’s likely some bumps in trying to figure out how data is condensed and reported and for what time,” said Ciborowski, whose organization represents aging-related nonprofits. “It sounds like the Department of Health is still figuring out some of those details.”

Del. Kirill Reznik, a Montgomery County Democrat, said lawmakers will likely discuss the data discrepancy and other concerns about nursing home outbreaks at a legislative hearing Thursday.

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“The data is what the governor has based all of his planning on,” Reznik said. “If the data is wrong or if the data is fudged, that has massive effects on whether or not we’ve crossed the hump of this pandemic or whether or not we should expect a second wave.”

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