Is the End of the Long-Term Care Crisis Within Sight? New COVID-19 Cases and Deaths in Long-Term Care Facilities Are Dropping

The final months of 2020 were the deadliest months of the pandemic for many long-term care facilities (LTCFs) across the country, with over 26,000 COVID-19 deaths in LTCFs reported between Thanksgiving weekend and December 31, 2020. The end of 2020 also saw the approval of the first coronavirus vaccines and the launch of vaccine administrations in LTCFs through the Pharmacy Partnership for Long-Term Care on December 21st, 2020 (Pfizer-BioNTech) and December 28th, 2020 (Moderna). As of February 22, 2021, about 4.5 million residents and staff have received one or more dose through the Partnership; over 2 million residents and staff have received both doses. In addition, some states and some LTCFs have vaccinated residents or staff outside the Partnership. Vaccinations have increased outside of LTCFs as well, though at a significantly lower rate.

This analysis compares trends in new COVID-19 cases and deaths among nursing facility residents with trends in all other new COVID-19 cases and deaths excluding nursing facility residents through February 7, 2021. Our prior analysis of trend data going from April 2020 through December 2020 found similar patterns in cases and deaths in long-term care facilities and in the general population. This updated analysis with more recent data shows a marked divergence in new cases and deaths per week between nursing facility residents and the rest of the US population since December 2020. This drop in new cases and deaths in nursing facility residents coincides with the start of vaccine administration in LTCFs, suggesting a link between the two, although the trends could also be influenced by other factors. See Methods for more details on data sources and analysis.

Weekly new deaths among nursing home residents have decreased by 66% since long-term care vaccination efforts started at the end of December, compared to a 61% increase in all other new deaths not among nursing home residents during the same period (Figure 1 and Table 1). In the period leading up to initiation of vaccination efforts in LTCFs, new deaths among nursing homes residents and non-nursing home residents had generally been increasing since late Fall 2020, peaking in the week ending December 20, 2020. Starting December 21, 2020, the week LTCF vaccination efforts began, weekly nursing home resident deaths began a steady decrease, which has continued through the most recent week of data available, dropping from 6,019 for the week ending December 20, 2020 to 2,054 for the week ending February 7th, 2021. The rate of decrease appears to have accelerated in recent weeks, as more LTCF residents got fully vaccinated. In contrast, non-nursing facility resident deaths increased overall (from 12,325 to 19,848 weekly deaths between the weeks ending December 20th 2020 and February 7th, 2021), with a slight drops the weeks ending December 27th and January 24th.

Figure 1: Weekly COVID-19 Nursing Home Resident and Non-Nursing Home Resident Deaths in the US, June 2020 – February 2021

Similarly, weekly new cases among nursing home residents have been steadily declining since December 20, 2020 and decreased faster than cases among non-nursing home residents (-83% and -45%, respectively) (Table 1). As has been widely reported, overall cases in the US have dropped precipitously in recent weeks. While cases have dropped both within and outside nursing facilities, new nursing facility resident cases peaked earlier (week ending December 20, 2020) as compared to in the general non-nursing facility resident population (week ending January 10, 2021) and declined at a faster rate in nursing facilities than outside nursing facilities.

While timing of vaccine initiation in LTCFs and declines in cases and deaths coincide and suggest a link between the two, it is still unclear how much of the decline in cases and deaths can be attributed directly to the vaccine. In particular, cases and deaths started declining upon rollout of the Partnership, but first vaccine clinics did not happen immediately in all locations. According to the CDC, there has been strong evidence that the vaccines prevent severe illness and death, and the sharp divergence in deaths inside and outside of LTCFs is consistent with that evidence. In addition, given the emerging research around the vaccines’ ability to prevent transmission of the virus, there is reason to believe that the vaccine may be playing a part in reducing virus transmission within nursing homes, contributing to the more rapid decline in new cases in nursing facility residents than in the overall population.

Table 1: Weekly COVID-19 Nursing Home Resident and Non-Nursing Home Resident Cases and Deaths in the US,
June 2020-February 2021
Week Ending Weekly New Cases Weekly New Deaths
Nursing Home Resident Non-Nursing Home Resident* Nursing Home Resident Non-Nursing Home Resident*
6/7/2020 16,396 129,022 2,750 2,748
6/14/2020 12,998 133,847 2,078 3,082
6/21/2020 12,128 172,346 1,725 2,400
6/28/2020 13,440 254,681 1,468 2,291
7/5/2020 13,940 331,146 1,472 1,946
7/12/2020 16,837 387,405 1,612 3,266
7/19/2020 18,442 441,362 1,802 3,403
7/26/2020 18,918 440,663 2,050 4,312
8/2/2020 17,180 408,973 2,073 5,850
8/9/2020 16,737 346,790 2,081 5,252
8/16/2020 15,970 341,317 1,879 5,565
8/23/2020 13,585 280,810 1,730 5,073
8/30/2020 12,476 273,774 1,543 4,829
9/6/2020 11,458 265,877 1,364 4,462
9/13/2020 10,226 227,709 1,219 3,754
9/20/2020 10,513 267,305 1,176 4,233
9/27/2020 10,546 295,021 1,139 4,080
10/4/2020 10,815 287,727 1,186 3,618
10/11/2020 11,927 330,372 1,247 3,628
10/18/2020 14,781 367,899 1,468 3,297
10/25/2020 16,350 464,261 1,736 3,881
11/1/2020 18,760 613,883 2,012 3,690
11/8/2020 23,673 775,164 2,464 4,584
11/15/2020 30,164 1,014,806 2,982 4,940
11/22/2020 32,665 1,165,545 3,721 6,624
11/29/2020 27,641 1,094,863 4,582 5,424
12/6/2020 32,031 1,345,600 5,043 10,229
12/13/2020 33,428 1,448,948 5,762 11,170
12/20/2020 33,601 1,468,084 6,019 12,325
Nursing Home Vaccinations Begin
12/27/2020 28,815 1,240,812 5,586 9,679
1/3/2021 27,144 1,459,024 5,474 12,853
1/10/2021 25,887 1,683,067 5,326 16,984
1/17/2021 21,349 1,489,336 4,958 18,206
1/24/2021 17,383 1,163,988 4,341 16,926
1/31/2021 11,084 1,012,715 3,164 18,738
2/7/2021 5,672 812,362 2,054 19,848
Percent Change From 12/20/2020 to 2/7/2021 -83% -45% -66% 61%
NOTES: Nursing home cases/deaths include resident cases and deaths only. *Non-nursing home resident cases and deaths calculated as total US cases and deaths minus nursing home resident cases and deaths. These figures include nursing home staff cases and deaths.
SOURCES: Nursing home cases and deaths are from CMS COVID-19 Nursing Home Data, as of the week ending on 2/7/2021. US weekly cases and deaths data is based on analysis of COVID Tracking Project data.
Methods
This analysis uses federal data on coronavirus cases and deaths in nursing facilities, which includes weekly data as of mid-May 2020 through February 7th, 2021. This analysis defines nursing facility cases and deaths as cases and deaths among nursing facility residents. Cases and deaths among nursing home staff are included in “non-nursing home resident” group. Data on non-nursing home cases and deaths are calculated based on the number of nationwide cases and deaths from the COVID Tracking Project minus nursing home resident cases and deaths; we make this adjustment to account for possible endogeneity (that is, cases or deaths in nursing homes contributing to the patterns in COVID-19 cases and deaths nationwide), particularly for deaths where long-term care deaths account for approximately 37% of overall COVID-19 deaths. The federal data includes only data on federally certified nursing facilities. This analysis therefore does not include data on other long-term care settings, such as assisted living facilities, residential care facilities, group homes, or intermediate care facilities.

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