Did Andrew Cuomo’s nursing home policy cause over 1,000 Covid-19 deaths? It may have led to spike, says report
New York Governor Andrew Cuomo has faced increasing scrutiny regarding a directive last year that prohibited the state’s nursing homes from denying admission to residents infected with coronavirus. A report now suggests that the since-rescinded March 25, 2020, memo could have led to more than 1,000 deaths in nursing homes.
“The admission of coronavirus-positive patients into New York nursing homes under March 25 guidance from the New York State Department of Health was associated with a statistically significant increase in resident deaths. Statewide, the findings imply that Covid-positive new admissions between late March and early May, which numbered 6,327, were associated with several hundred and possibly more than 1,000 additional resident deaths,” says the analysis by the Empire Center, a non-profit think tank located in Albany, New York.
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An earlier investigation led by New York Attorney General Letitia James had stated that the New York State Department of Health underreported coronavirus deaths in nursing homes by 50%. “Since March, attorney General Letitia James has been investigating nursing homes throughout New York state, based on allegations of patient neglect and other concerning conduct that may have jeopardized the health and safety of residents and employees. Among those findings were that a larger number of nursing home residents died from Covid-19 than the New York State Department of Health’s published nursing home data reflected and may have been undercounted by as much as 50%,” it alleges.
The latest analysis focuses on two variables: the number of newly admitted coronavirus-positive patients to each nursing home between March 25 and May 8, which totals 6,327, and the number of residents in each facility who died between April 12 and June 4, which amounts to 5,780.
“The shift in dates reflects the typical delay between exposure to the virus and death, which the health department has said ranges from 18 to 25 days. The assumption was that deaths occurring before April 12 or after June 4 were less likely to be related to the admission of positive patients under the March 25 policy. The admissions figures exclude 2,279 patients who were readmitted to nursing homes where they were already residents,” explain the authors.
The data reveal that each new admission of a Covid-19-positive patient correlated with .09 additional deaths, with a margin of error of plus or minus 0.05. Further, admitting any number of new coronavirus-positive patients was associated with an average of 4.2 additional deaths per facility. Among nursing homes outside of New York City and its suburbs, each positive admission was associated with 0.62 additional deaths, and any number of positive admissions was associated with 9.33 additional deaths per facility.
The models indicate that transfers from hospitals to nursing homes were significantly associated with nursing home deaths upstate but not downstate, where the population-wide infection rate was exceptionally high during the period in question.
“The effect was more pronounced upstate, possibly because the pandemic was less severe in that region at the time so that even a single exposure would have had a larger impact on the level of risk. Also in the upstate region, facilities that admitted at least one positive patient during this period accounted for 82% of coronavirus deaths among nursing home residents, even though they had only 32% of the residents,” notes the team.
According to the investigators, the findings were calculated with “statistical significance at the 99 percent confidence level". They emphasize that the guidance may have made a “bad situation worse".
“The data indicate that the March 25 memo was not the sole or primary cause of the heavy death toll in nursing homes, which stood at approximately 13,200 as of early this month (February 2021). At the same time, the findings contradict a central conclusion of the health department’s July 6 report on coronavirus in nursing homes, which said, among other things: ‘Admission policies were not a significant factor in nursing home fatalities’ and ‘the data do not show a consistent relationship between admissions and increased mortality’,” conclude authors.