Admission of COVID-19 patients to SNFs likely increased cases and related deaths

Admitting patients with COVID-19 to skilled nursing facilities (SNFs) increased subsequent COVID-19 cases and associated deaths at the SNFs, a new study found.

The cohort study used survey data from the CDC's National Healthcare Safety Network covering June 2020 to March 2021. A total of 264 facilities that admitted COVID-19-positive patients (exposed facilities) were matched to 581 facilities that were in the same counties and had similar preadmission case counts but hadn't newly admitted COVID-19-positive patients (control facilities). Results were published by JAMA Internal Medicine on June 3.

Over the study's 15 weeks of follow-up, exposed SNFs had 6.94 (95% CI, 2.91 to 10.98) additional COVID-19 cases per 100 residents compared with the control SNFs, a 31.3% increase compared with the mean of 22.2 cases per 100 residents. There were also 2.31 (95% CI, 1.39 to 3.24) additional COVID-19-related deaths per 100 residents in the exposed facilities compared with control facilities, a 72.4% increase over the mean of 3.19 per 100. If the exposed facilities had shortages of staff or personal protective equipment (PPE), the increase was even greater (an additional 10.97 [95% CI, 2.76 to 19.19] or 14.81 [95% CI, 2.38 to 27.25] cases per 100, respectively).

The study authors noted that an important distinction between this study and other similar research about spread of the virus is that the SNFs were aware of the patients' COVID-19 status at admission and "thus, in theory, could have implemented strict infection control protocols, including isolating newly admitted patients, requiring use of full PPE (including N95 masks), and conducting more frequent COVID-19 testing of staff and residents to detect and mitigate potential spread."

SNFs may have struggled to implement all these steps, the authors noted, and therefore the study's results "speak to the importance of equipping SNFs to adhere to infection-control best practices as they face the continued challenges posed by COVID-19 strains and other respiratory diseases, such as influenza and respiratory syncytial virus."

An accompanying editorial said that the findings should stir outrage, noting, "No individual with the slightest knowledge of nursing homes could have forced nursing homes to admit patients with COVID-19." The editorialists listed a number of steps that could be taken to mitigate these risks in the future, including reducing the number of SNF residents, paying staff for sick time, increasing staffing, and using more single rooms for residents.