Analysis: Nursing Homes, Other Group Living Settings, Skew NJ’s COVID-19 Rates

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Credit: NJTV NewsPatients from St. Joseph’s Senior Home in Woodbridge were evacuated March 25 after multiple residents contracted COVID-19 and some died.

New Jersey health officials can’t say who are among the thousands of new positive COVID-19 cases reported daily — health care workers, grocery store clerks or people who violated social-distancing orders — but data shows that group living situations are responsible for significant proportions of cases and deaths to date.

An analysis by NJ Spotlight of publicly available data from multiple state agencies found that more than 17% of the nearly 114,000 who have tested positive for the deadly virus since its outbreak in New Jersey March 4 are in such group settings as nursing homes, developmental centers and prisons. More than a third of the 6,442 confirmed deaths to date, or 2,253, are related to these facilities.

The deadly spread of COVID-19 through group living statewide — nursing homes and other long-term care facilities, in particular — has sickened close to 20,000 residents and staff alike and left thousands of families grieving for grandparents, children and friends. It also indicates that fewer cases of the virus than many thought are circulating outside the walls of such facilities.

The question of who is currently infected and how they got sick is a crucial one as New Jersey considers when and how to reopen, with many residents worried about how prevalent COVID-19 is in their communities and whether they will be at risk of getting the virus if they go back to their normal routines.

“People will not want to go out and be participating members in our economy if they are fearful we have not done all that we can to protect them from COVID-19,” Gov. Phil Murphy said Tuesday during the daily press briefing in announcing his creation of a committee to advise him on lifting his March 21 stay-at-home order and reopening stores, parks and other businesses.

A Monmouth University Poll released Monday bears that out. It found widespread trepidation among New Jerseyans over the virus: 61% were very concerned about someone in their family getting seriously ill from COVID-19, with another 26% somewhat concerned about a loved one getting sick.

Precision about positive cases is elusive

After the state recently began releasing data about cases in long-term care facilities, business leaders and public officials preparing for the reopening and people who will be expected to go back to a crowded workplace began asking questions about how widespread COVID-19 is among the general public. Health care workers and first responders in particular are at greater risk of exposure, but grocery store workers and others deemed essential also have a greater chance of coming into contact with the virus by virtue of their interactions with the public.

Ed Lifshitz, medical director of the state Department of Health’s communicable disease service, said it is virtually impossible to say exactly who is testing positive.

“We certainly know that far too many health care workers are becoming infected and that is certainly a great concern for a lot of reasons,” Lifshitz said during Monday’s briefing. “There’s no easy way for us to tease out the information since this is largely self-reported until an investigation happens. And with so many cases, investigations take a long time.”

Parsing out the data that is available for places where people are living outside of day-to-day society provides at least a partial answer. NJ Spotlight gathered the most recent information available from several state agencies that are releasing data for long-term care centers, veterans’ hospitals, psychiatric institutions, youth and adult prisons and developmental centers and group homes. Whenever possible, the numbers include cases of staffers working in facilities as well as those living in them; the notable exception is the long-term care data, where the portion of cases among staff is unclear.

Nursing homes and similar facilities make up the lion’s share of group cases — as of Tuesday, 484 long-term care facilities are responsible for 88% of 19,544 positive tests and 91% of the deaths in group living settings. Another 824 cases and 57 deaths were reported as of Sunday in the state’s five developmental centers and an unknown number of group homes throughout the state. As of Monday, there were 683 known cases and 29 deaths in the state’s prisons. Three veterans’ hospitals reported 268 cases and 102 deaths as of Tuesday. Five psychiatric hospitals had 538 cases and 14 deaths as of Monday. And federal officials reported 30 cases among immigrant detainees in New Jersey jails and the main detention center in Elizabeth Tuesday. Not included because they are not reported uniformly are cases of regular inmates or staff of county jails.

Living in confined spaces

Health experts said that based on past experiences with the flu, it would not be surprising to see that this virus has spread rapidly within long-term care and other group settings where people spend much of their time in a confined space. But COVID-19 has proven much more contagious — with each infected person passing it on to an estimated three to five others, compared with fewer than two additional infections for the flu, said Dr. Tanaya Bhowmick, assistant professor of medicine specializing in infectious diseases at Robert Wood Johnson Medical School.

“It is important to note that people have received flu vaccine, so that makes the spread a little less for that, because there’s a component of ‘herd immunity,’” she said. “Moreover, COVID-19 is a novel strain which people have never been exposed to, so it can spread more rapidly.”

Dr. Judith Lightfoot, chief of infectious disease at Rowan University School of Osteopathic Medicine, said the virus likely spread more quickly through long-term care facilities when some staff members working in more than one home carried the virus from place to place. Nursing home aides are often low-paid and need to work multiple jobs. In addition, a person can spread COVID-19 as many as three days before showing symptoms.

“The nuances of this virus make it probably 10 times more lethal than the flu,” she said. “The United States was not prepared at all for this. We have had to play catch up … There is still going to be more loss of life.”

The impact of group cases of COVID-19 is significant when looking at the rate of known positive tests. Statewide, the case rate for the virus drops from 12.8 per 1,000 of overall population to 10.7 when group data is removed. On the other hand, the case rate within the population living in group settings is more than 10 times higher — around 200 cases per 1,000.

For some counties, group settings appear to be responsible for an especially large portion of their COVID-19 cases. In Cape May County, for instance, close to 38% of all cases can be attributed to group living, leaving the county’s infection rate at little more than two positive tests per 1,000 residents.

All the data only considers known cases and deaths confirmed by testing. The actual infection rate in the state is unknown due to the small amount of testing being done — 210,000 tests in a state with 8.9 million people. There are also potentially another 1,060 deaths that happened in long-term care facilities that are suspected to be due to COVID-19, but these have not been confirmed by laboratory testing and so are not yet reported in the state’s tally of total deaths.

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