Industry says more testing is needed to detect and curb outbreaks, and some states boost efforts

The number of U.S. coronavirus-linked deaths in long-term care facilities including nursing homes has eclipsed 10,000, as nursing-home owners said they are still struggling to access the testing they need to detect and curb outbreaks.

A growing number of state health departments are reporting data, including fatalities, linked to facilities that primarily house older people who often are in frail health and particularly vulnerable to infection from the new coronavirus.

Some states still haven’t reported data on deaths in such facilities, including Ohio and Washington, but a Wall Street Journal survey has found at least 10,700 fatalities among more than 35 states that either report data online or responded to requests for information. The overall U.S. reported death toll from the new coronavirus passed 46,000 on Wednesday, according to data from Johns Hopkins University

Evidence that such facilities remain at risk amid the pandemic could inform decisions on how to go about reopening businesses, hospitals, schools and other places that have been closed by official edict. Nursing homes might decide to continue barring all visitors, for example, even if other businesses such as barber shops, bowling alleys and restaurants partially open to customers. Currently, the federal Centers for Medicare and Medicaid Services requires nursing homes to tightly restrict who is allowed inside.

Elderly residents of facilities are “very uniquely vulnerable,” due to their age and the close-set nature of the living arrangements, said Patricia Stone, a professor at the Columbia University School of Nursing. As states consider reopening their economies, she said, “in nursing homes, we definitely need better testing before we can reopen, and until we have that, they should not be on the list.”

Despite the current ban on most visitors to nursing homes, limited testing has meant that some staffers without symptoms of Covid-19, the illness caused by the novel virus, likely brought infection into the facilities, she said.

The virus has hit at least 4,800 facilities, states have reported. The number of people infected, including residents and staff, totals more than 56,000. Some states, such as California, are reporting details on facilities, including in some cases names of places that have Covid-19 patients, but aren’t releasing fatality data. Meanwhile, some states may only report on nursing-home and assisted-living centers while others will include numbers from other adult-care centers such as behavioral-health facilities.

A growing number of states in the past week, including New York, Florida and California, started listing the names of facilities that have cases of Covid-19. This follows complaints from patient advocates and others who said there wasn’t enough transparency for family members with loved ones in these homes, or those looking for a safe place for a relative.

CMS said over the weekend it would require nursing homes, which CMS regulates, to report Covid-19 cases directly to the Centers for Disease Control and Prevention. CMS said it plans to report results publicly through its Nursing Home Compare site, which helps consumers assess nursing homes.

The federal government hasn’t generally been reporting data on cases and deaths linked to long-term care facilities. The Journal recently reported details showing a far greater impact on long-term care facilities than the CDC had to that point disclosed in what the agency said were snapshots based on informal outreach from the agency.

The first major Covid-19 outbreak in the U.S. occurred in a nursing home outside Seattle, leading to at least 40 deaths, and higher death tolls have since cropped up at facilities in New York and Massachusetts.

In some cases, the death toll in these settings has represented a significant share or even a majority of overall deaths reported by a state. In Minnesota, a spokesman for the state health department on Wednesday said 131 of 179 total deaths were linked to long-term care facilities.

In hard-hit Massachusetts, the state on Wednesday reported that 55% of its 2,182 Covid-19-linked deaths were in nursing homes and other long-term care facilities there. Among them is a veterans’ nursing home in Holyoke, Mass., where at least 55 deaths have been linked to the disease.

States report their numbers differently. Massachusetts only reports cases at these facilities that are confirmed by tests. In New Jersey, which recently reported 2,050 deaths linked to such sites, the tally includes both laboratory-confirmed cases and deaths that are suspected to be related to a continuing outbreak, a spokeswoman for the state health department said.

Nursing-home owners and researchers said the full extent of the problem may still be unclear, because some facilities aren’t able to do enough testing to confirm the size of outbreaks—which also makes it difficult to halt the virus’s spread.

Donny Tuchman, chief executive of Cobble Hill Health Center, a nursing home in Brooklyn for which the state of New York has reported 55 deaths tied to the coronavirus, said only one of the residents whom he counted as coronavirus fatalities had actually tested positive for the virus. The rest had been diagnosed based on symptoms, he said, adding that he had only reported 50 deaths, not 55. “We had great difficulty in obtaining tests for our residents,” Mr. Tuchman said.

A spokeswoman for the New York state department of health didn’t immediately respond to a request for comment.

“If we don’t know where it is, and we don’t identify the asymptomatic residents and staff, then we have no ability to implement effective infection prevention and curb the transmission,” said Morgan Katz, an assistant professor at Johns Hopkins University. In facilities where she and colleagues have done broad testing, she said, 60% to 70% of those residents with positive tests haven’t had obvious Covid-19 symptoms.

The American Health Care Association, which represents nursing homes and assisted-living facilities, said its members need to be able to test all staff and residents and get timely results, and they have struggled to get that access. “This has been one of the most significant factors related to the spread,” the group said. LeadingAge, which represents nonprofit providers of aging services, said nursing homes don’t have sufficient access to tests.

A spokeswoman for the Department of Health and Human Services said that all three top-priority categories for Covid-19 testing should be tested, and people who provide care at long-term care facilities should be at the highest priority because they are health-care facility workers.

Several nursing-home operators said they can’t always access testing with fast results for staffers, particularly those without symptoms, who researchers say are the most likely source of many nursing-home coronavirus outbreaks. “Without testing, how can you know where this virus is, and who is at risk?” said Martin Goetz, chief executive of River Garden Senior Services, in Jacksonville, Fla., which includes both a nursing home and independent senior living. He said he has no known cases of Covid-19 among residents or staff.

Florida is already deploying teams to elder-care facilities around the state to ramp up testing, the state has said. The state’s health department didn’t immediately respond to a request for comment.

On Friday, West Virginia Gov. Jim Justice issued an executive order directing state health authorities and the National Guard to test every nursing-home resident and staff member in the state.

Massachusetts authorities have tried multiple approaches to broaden testing. In early April, this included augmenting a National Guard testing program by giving nursing homes and related facilities the option of collecting samples with test kits from a local laboratory.

More than 150 facilities asked for more than 14,000 kits, according to the state’s public health department. But only about 4,000 samples were returned, and many were in unusable condition due to problems such as leaks and missing labels, said Ann Scales, a spokeswoman for the state public-health department, in an email.

The state has decided to halt this self-testing option, Ms. Scales wrote: “Effective immediately, facilities calling the call center and requesting testing will be offered on-site professional testing by MA National Guard or an EMS provider.”

Wall Street Journal

By Jon Kamp and Anna Wilde Mathews

Updated April 22, 2020 7:14 pm ET

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