How Did VDH Miss 1,100 Suspected Cases?

by Carol J. Bova

When Governor Northam announced the release of the Virginia Health Department (VDH) COVID-19  details for specific nursing homes and assisted living facilities on June 19, he explained the reversal in policy: “It is also important that this information is released now, given inconsistent information reported at the federal level.” The governor’s Virginia Long-Term Care Task Force posted the names of facilities, the outbreak status, when it was reported to the Virginia Department of Health (VDH), and the number of COVID-19 cases and deaths.

The governor probably did not expect that federal information from The Centers For Medicare And Medicaid (CMS) COVID-19 Nursing Home Dataset would reveal that the VDH Task Force report missed 45 nursing homes that had reported more than 1,100 suspected COVID-19 cases to CMS. More than 500 suspected cases are nursing home staff members, and the others are residents. These numbers reflect only facilities not on the Task Force list and do not include any of those with an outbreak in progress.

Some of those suspected cases may have been ruled out in the past two weeks, and some may have been confirmed as COVID-19 cases, adding to the outbreak numbers.

In mid-April, the governor announced the Task Force would set up point prevalence testing at any facility with at least two cases. This testing not only identifies anyone who has the virus, but anyone who may be asymptomatic or pre-symptomatic. Without that information, a person can inadvertently spread the virus.

This week, the Roanoke Times reported, “As of June 14, the Health Department, with assistance from the National Guard, had completed 60 of the 154 requests for point prevalence studies by long-term care facilities. Three-quarters of the requests are for nursing homes. A breakdown of the remaining long-term care requests shows that 11 requests were submitted but not scheduled, 61 are on a schedule, 13 had specimens collected that are pending results, three facilities withdrew their requests and six need to provide more information before their requests will be processed.”

Today’s outbreak tab on the Virginia COVID-19 Dashboard headlines, “All Health Districts Cases in Healthcare Workers: 3,607,” and shows 230 Outbreaks for Long Term Care Facilities (LTCF) with 6,549 cases and 1,004 deaths. It does not give the number of cases involving healthcare workers in nursing homes or assisted living facilities, but we do know nursing homes have reported 11 deaths, 880 confirmed cases, and at least 1,500 suspected worker cases to CMS.

Did we learn nothing from the tragic events at Canterbury Rehabilitation where 53 of 92 tests came back as positive for asymptomatic individuals? As the LTCF outbreak numbers climb, day by day, why haven’t the Governor, the health commissioner and others acted to get the point prevalence testing completed since April? Why is it acceptable to plan for two more months of not knowing while unrecognized asymptomatic and pre-symptomatic workers risk spreading the virus to citizens both inside and outside the nursing homes? And don’t those workers deserve the peace of mind of knowing if they are not infected?

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6 responses to “How Did VDH Miss 1,100 Suspected Cases?

  1. My hypothesis large part COVID story in Virginia relates to nursing homes and health care workers in those homes, who may visits various facilities. In addition there is the incredible data about how the Hispanic population in NoVA was so heavily impacted, which I wonder if there is a nexus to the nursing home story somehow. Manassas region continues to show upsurge which they said on WTOP news yesterday (CDC?) is going to study to see if any learnings for the future, but significant Hispanic population is part of it.

  2. VDH changed definitions mid-stream on race/ethnicity: Previously they followed the Census Bureau’s definition.
    “The U.S. Census Bureau adheres to the U.S. Office of Management and Budget’s (OMB) definition of ethnicity. There are two minimum categories for ethnicity: Hispanic or Latino and Not Hispanic or Latino. OMB considers race and Hispanic origin to be two separate and distinct concepts. Hispanics and Latinos may be of any race. Thus, the percent Hispanic should not be added to percentages for racial categories.”

    On June 14, VDH changed the categories to remove Hispanic from white, other or unknown (but not black) and create a new “race” as Hispanic instead of treating Hispanic as an ethnicity which can be of any race. The category Other was subdivided into Asian/Pacific Islander, Native American, Two or more races and Other.

    The number of Unknown cases, 14,200, is a quarter of all cases. So VDH does not know the true percentage of cases by race and can’t make a valid comparison to population numbers using the Census definitions.

    The VDH death rate percentages of COVID-19 are a more accurate representation:
    Asian/Pac.Islander ….91…….5.6%
    Black……………………..347…..21.5%
    Latino……………………..171….10.6%
    Native American………….1……0.1%
    Other…………………………22…..1.4%
    Two or more………………..0…….0.0%
    White………………………..878…54.4%
    Unknown…………………..101……6.3%
    Total Deaths:…………. 1,611…100.0%

    The CDC Virginia death certificate number for Hispanics is 10.2% for COVID-19 alone and COVID-19 and Pneumonia together as of 6/10/20.

    Northam’s bilingual presentation with 45% Hispanic cases Friday was a case of political accounting, not epidemiological.

  3. TBill, you’re right about the LTCF workers going to more than one job as a factor in spreading the virus. That’s why Leading Age Virginia and others asked VDH in early April for the locations of nursing homes with COVID-19, and Norman Oliver announced on April 21 that LTCFs could share information with each other.

  4. Why can’t the owners of those nursing homes do that testing? Don’t they owe that to their residents and staff?

  5. Good question. You would think that’s the case, and some have done testing on their own. The answer on the others from press reports is cost. This from WAVY May 20: “The American Health Care Association and National Center of Assisted Living argues more resources need to be committed to testing in nursing homes. The organization says it would cost $8.7 million to test every nursing home staff member and resident in Virginia–nearly 58,000 people total across 287 facilities. This does not include the cost of testing at assisted living and other long-term care providers, according to the organization.”

    Once the governor committed on April 17 to do the point prevalence testing as a public health effort for any nursing home with two or more cases, it let others sit back and wait so they won’t have to pay for it.

  6. The Virginia Mercury on June 4 cited another reason nursing homes aren’t testing, and why some opted out of the point prevalence studies quoting Dr. Danny Avula, director of the Richmond and Henrico Health Departments.
    “He added that it’s far outside the norm for facilities to pursue widespread testing on their own. Multiple state officials acknowledged that some nursing homes have declined point prevalence surveys from VDH (Avula could think of at least two in his district). Many nursing homes — historically understaffed and low-funded health care settings — are afraid that baseline testing might expose large numbers of asymptomatic employees, who would then be required to isolate for two weeks, exacerbating existing staffing problems.”

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