An official federal government tally missed nearly 16,000 COVID-19 nursing home deaths that occurred during the early months of the pandemic, according to new research published Thursday.
Those missing numbers account for 14 percent of all nursing home deaths in 2020, the study found.
Across the 20 states with available data, the study, led by Harvard researcher Karen Shen and published in the JAMA Network Open, found that 44 percent of all COVID-19 cases and 40 percent of COVID-19 deaths in nursing homes counted by state health departments went unreported in the federal data.
When the findings were applied to the entire country, the researchers found 592,629 uncounted cases and uncounted 118,335 deaths in nursing homes by the end of 2020.
But the delay in federal reporting, coupled with wide disparities in the quality of state data, could mean the true toll of COVID-19 on nursing home residents may never be known.
The Trump administration first imposed a requirement for nursing homes to report weekly cases and deaths on May 24, 2020, through the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
But nursing homes were not required to report retroactive data, and it's not known how many facilities chose to do so. There were no common characteristics among the facilities that didn't report.
"This may demonstrate a widespread inability of nursing homes to reliably collect data early in the pandemic or that pressures to report fewer cases and deaths were common to all facilities," the researchers wrote.
For example, the study noted that Life Care Center of Kirkland, which was the site of the first COVID-19 outbreak in the U.S, reported zero cumulative COVID-19 cases in the first submission to CDC, despite a March 2020 CDC investigation that identified 81 COVID-19 cases and 23 COVID-19 deaths among residents.
The unreported cases and deaths represented a significantly larger share of year-end totals in the Northeast, where states were hit hard by the first wave of the pandemic in the spring of 2020.
For example, federal data shows similar numbers of nursing home residents died in New York and California in 2020.
However, after accounting for unreported deaths, the study estimated that nursing homes in New York experienced about eight deaths per 100 beds, compared with 5.5 deaths per 100 in California.