Massachusetts nursing homes were ground zero for COVID-19, reporting some of the highest death rates in the country, especially in the early months.
But now, more than a year after the pandemic began its ravages, state officials say the death toll was not quite as high as previously reported. They’re revising downward the number of fatalities by more than 1,200, based on a change in the way they report long-term-care deaths on the state’s weekly COVID-19 dashboard.
Starting Thursday, the officials said, Massachusetts adopted the Centers for Disease Control and Prevention’s widely used National Healthcare Safety Network tracking system. That system doesn’t count as COVID-19 deaths residents and staff at nursing homes and rest homes who recovered from the virus but later died of other causes.
With that change, the number of COVID deaths in Massachusetts nursing homes over the 13-month pandemic fell from 6,722 to 5,502, a drop of more than 18 percent. The decline would knock Massachusetts out of the top 10 states with the highest nursing home death rates, based on data collected by the Kaiser Family Foundation.
Marylou Sudders, the state’s secretary of health and human services, denied state officials were trying to make their response to the pandemic at nursing homes look better by reducing the death count.
New York Governor Andrew Cuomo faced intense criticism after it was revealed that his administration had reduced the total number of nursing home deaths by excluding nursing home residents who died at the hospital. Massachusetts officials say they’ve always included residents who were hospitalized in the long-term-care death numbers.
The issue in Massachusetts, said Sudders, is just a change in definition to be more consistent with national standards. The state Department of Public Health already collects data under the new standard and submits them to the CDC, but hasn’t posted them on its widely viewed dashboard.
“We’re aligning our definition with how the feds want to report long-term-care deaths and we’re aligning with other states,” Sudders said.
Until now, the state’s COVID-19 dashboard — updated each Thursday — has used a different CDC standard, the so-called surveillance case definition. That includes in the COVID-19 death count anyone who tested positive and later died, regardless of whether the virus was a cause of the death.
State officials will be reposting weekly death data going back to last year under the new standard. But they said they will retain the previous standard for reporting overall COVID-19 deaths in Massachusetts on the weekly dashboard. As a result, the state’s total COVID-19 death count will not shrink.
State officials said they will include a footnote in this week’s report explaining the change. Information on long-term deaths are self-reported by nursing homes and other facilities.
On the state’s daily COVID-19 dashboards, an even higher figure had been listed for long-term care deaths — 9,018 deaths as of Wednesday. State officials said the daily data, which was removed from the dashboard Thursday, had used an “expansive” definition collected from death certificates.
Two independent analysts who track national COVID-19 data in long-term-care facilities said the new standard Massachusetts is embracing appears to be reasonable.
“It makes a lot of sense to mirror what the CDC is doing,” said David Grabowski, a health policy researcher at Harvard Medical School, who likened some state coronavirus websites early in the pandemic to the “wild West” of data reporting.
“If a person had COVID and they died six or nine months later, is that a COVID death?” he said. “I tend to think not.”
Grabowski said, however, that long-lingering symptoms suffered by some who recovered from COVID-19, as well as loneliness and isolation from families, likely contributed to many nursing home deaths not directly attributed to the virus.
Priya Chidambaram, a senior policy analyst with the Kaiser Family Foundation, said several other states, including Ohio, Wisconsin, and Iowa, have changed the way they report long-term-care deaths over the course of the pandemic, sometimes increasing their death toll and sometimes lowering it.
“It sounds like Massachusetts wants to be able to compare their data with other states,” she said. “But there’s still a lot of variation in the way states report their data so it’s not clear Massachusetts will be able to do that immediately.”
Representative Ruth Balser, a Newton Democrat who was lead sponsor of legislation that now requires more transparent reporting from the state on nursing home-related COVID-19 deaths, said she understood the goal of having states report deaths the same way.
But Balser said she had questions about the state’s change.
“Our goal in the Legislature was to know who in the nursing home got COVID-19 and died from it,” she said. “So I am wary if the system changes and that makes it harder for us to understand what happened in our nursing homes.”
Sudders said the change will make Massachusetts consistent with the CDC’s long-term-care death data — used by many health researchers — and with other states that use its National Healthcare Safety Network Standard. She said the change was also required by a state law, Chapter 93, that was passed last summer to expand reporting requirements and help the state better respond to clusters of cases or trends.
Although the state already was posting the required data elsewhere on its website, it had stuck with the earlier reporting system on its high-profile dashboard until now.
“We see it as a maturation of our dashboard,” Sudders said. “It will allow us to be consistent with what other states are reporting on their dashboards. The more we learn about COVID-19 in this pandemic, the more it allows us to make our data more precise.”
The new reporting system also will help state health officials “closely monitor the effect of COVID in a well-vaccinated but vulnerable population” in the coming months, said Dr. Catherine Brown, state epidemiologist at the DPH.
Early in the pandemic, she said, “the feeling was it was important to cast a broad net” in assessing the spread of the virus in senior sites, Brown said. Now, though, the state needs greater precision in tracking COVID-19′s tragic impact.
“Every life lost due to COVID-19 is a heartbreaking tragedy and DPH is dedicated to providing the most accurate and up to date information . . . to track this virus and understand its impact on our most vulnerable populations,” Brown said.