State health department documents from June 2020 newly uncovered by congressional investigators appear to show the harmful effects of a controversial order requiring nursing homes to admit positive COVID-19 patients.
The documents are likely to weaken, if not negate, the Cuomo administration’s long-standing argument that its March 25, 2020, order did not significantly affect the health of nursing home residents during the first wave of the pandemic.
They also suggest that state officials were aware of damaging evidence about the policy but did not disclose it to the public during the years of debate.
During the height of the COVID-19 pandemic in New York City, a March 25 order from the Health Department stated that nursing homes “must comply with the prompt admission” of patients discharged from hospitals and prohibited them from refusing residents who tested positive for COVID-19. Under this policy, which was in effect until May 10, 2020, more than 9,000 transfers were made.
A graph emailed to then-Health Commissioner Howard Zucker on June 7, 2020, showed that facilities that admitted infected patients under the order had higher COVID-19 death rates than facilities that did not admit such patients.
A graph reflecting statewide data showed that facilities with “any (COVID-19-positive) hospitalizations or readmissions” had a mortality rate of 8.1%, nearly double the 4.1% mortality rate for facilities with “no hospitalizations or readmissions” (see Figure 1).
In New York City, the percentage of facilities with residents was 6.8 percent, compared with 4.3 percent without residents (see Figure 2).
The document was revealed on Monday when the House of Representatives Select Subcommittee on COVID-19 released the results of its investigation into the March 25 order.
Cuomo is scheduled to testify at a subcommittee hearing in Washington on Tuesday, September 10.
The newly released graph was part of an email that Health Department official Dr. Eleanor Adams sent to Zucker on June 7, 2020. The subcommittee released the 22-page email on Monday, along with transcripts of interviews with Gov. Cuomo and nine former members of his administration.
According to investigators, in the early hours of June 7, the governor’s office decided to issue a report defending nursing home policies and ordered the health department to provide related information.
Adams sent Zucker a series of “talking points” defending the March 25 policy, along with slides of data he had previously collected.
Adams argued that the order “is unlikely to have led to an increase in nursing home deaths” given its timing, because deaths peaked earlier than the number of COVID-19 positive residents, for example.
The slides she included contained data to back up her claim, including a chart showing higher death rates in facilities that accepted transfers of COVID-19 positive patients.
The chart further analyzed mortality rates by dividing facilities into six categories based on the number of hospitalized patients.
Statewide, facilities in the highest category, where more than 50% of residents are hospitalized, had the highest death rate at 10.2%.
In New York City, facilities with the second highest hospitalization rates had the highest death rates, reaching 40-50% of residents.
This evidence is broadly consistent with an analysis published by the Empire Center in February 2021, which found a statistically significant correlation between hospitalization of COVID-19 positive individuals under the March 25 order and higher mortality rates in the facilities that admitted them.
The analysis suggests that while the policy is not the sole or even main cause of COVID-19 infections in nursing homes, it likely made a bad situation worse.
Adams’ arguments, in a revised form, formed the basis of a much-criticized report released by the Cuomo administration on July 6, 2020, that asserted that the March 25 order “was not a significant factor in nursing home deaths.” Although the report was released under the name of the Department of Health, the Assembly investigation found that, like previous Assembly impeachment investigations, the report had been edited and rewritten by staff in the Governor’s Office, including Cuomo himself.
Among other changes, the governor’s office removed data on nursing home residents who died after being taken to a hospital with COVID-19, a decision that reduced the published death toll by about a third, from 10,000 to 6,400.
The July 6 report also did not include any comparison of death rates by number of nursing home residents, including any of the data or graphs in Adams’ presentation.
