Cuomo’s Covid-19 Death Count Problem Goes Beyond Nursing Homes

New York Governor Andrew Cuomo’s most recent press release on the “state’s progress during the Covid-19 pandemic” reports that 37,556 people have died from the disease in New York. The state health department’s Covid dashboard gave the same count last time I looked.

Nobody else with any knowledge of the situation thinks that this is New York’s actual Covid death toll. Right after checking the state site I consulted the New York Times, which said the state’s Covid fatalities numbered 45,957.  At the Johns Hopkins Coronavirus Resource Center, which is where Bloomberg News gets the deaths data for its Covid tracker, the tally was 46,420. Even the Centers for Disease Control and Prevention, which often reports deaths with a lag of several weeks and thus usually puts out lower numbers than the states do, had it at 45,514.

You can’t really call the state government’s lowballing of Covid deaths a coverup, given how widely available the alternative numbers are. These other numbers are all based on reports from government entities within the state — the New York City Department of Health and Mental Hygiene and county health departments — and there’s no indication that anyone in Albany has tried to halt this flow of information.

The mechanics of why the state’s numbers are lower also seem less than sinister. The New York City health department, which has clearly gotten lots of questions about why its estimates are so much higher than the state’s (the state says 20,001 New York City residents have died of Covid-19; the city reports 23,546 confirmed Covid deaths and another 5,044 probable ones), now offers a handy explainer at its data repository on GitHub. To wit: the state’s numbers are derived from its Hospital Emergency Response Data System and “daily calls to hospitals and other facilities that are caring for patients, such as nursing homes” — meaning that only deaths at hospitals and other care facilities are counted — while the city enlists the resources of its medical examiners and Bureau of Vital Statistics, which is responsible for reporting and analyzing all deaths in the city.

In other words, the state Department of Health has been running a real-time monitoring system, a useful thing in the middle of a pandemic but not a source of reliable vital statistics. That’s understandable given that in New York the state health department doesn’t do vital statistics. As is the case in about half the states, New York has decentralized public-health governance, meaning that the county and New York City health departments are responsible for figuring out how many people actually died of Covid-19 (and of everything else) and reporting that to the CDC’s National Center for Health Statistics. But instead of incorporating their more-complete tallies into its totals, the state just keeps putting out its own obviously wrong numbers.

This is weird, but not entirely unique. There are three other states (Nebraska, Kentucky and Missouri), where the state-reported death toll is about as low relative to the CDC’s as New York’s, and one (Oklahoma) where it’s even lower. But none of those states’ governors is in the midst of a high-profile brouhaha over Covid-death reporting, and it struck me that the reporting practices outlined above may shed some light on said brouhaha.

At issue is the reporting of Covid deaths among residents of nursing homes and other long-term care facilities in the state. New York has been reporting Covid deaths at nursing homes all along, a number that is also tracked by the CDC. But while many states last spring began publicly reporting all Covid-19-related deaths among long-term-care residents, including those that occurred at hospitals, New York did not.

It wasn’t as if a person couldn’t come up with a rough estimate of the total death toll among New York nursing-home residents. Last summer, when I looked into these matters for a column, state and CDC data indicated that a bit less than 47% of the New Jersey nursing-home and long-term care residents who had died of Covid had died in hospitals, and it seemed reasonable to assume a similar percentage for the state next door.

Last month, New York Attorney General Letitia James finally got the Cuomo administration to cough up partial estimates of hospital Covid deaths among nursing home residents, and last week the state health department released a full accounting in response to a freedom-of-information lawsuit filed by the Empire Center, a conservative Albany think tank. According to this data, 37% of all confirmed and presumed Covid-19 deaths among residents of long-term care facilities in New York occurred outside of those facilities. The overall death toll, 14,771, was thus smaller than this outsider would have estimated before the state released the numbers.