The Pandemic’s Deadly Winter Surge Is Rapidly Easing

On January 28, after New York Attorney General Letitia James called attention to New York’s undercount of deaths in nursing homes, state Health Commissioner Howard Zucker issued a statement that attributed to New York State nursing homes an additional 3,829 deaths that occurred as far back as March 1, 2020. In the two weeks since this statement, New York has added a total of 5,620 deaths associated with nursing homes and long-term-care facilities to its dashboard, nearly doubling the state’s cumulative count of deaths associated with these facilities.

New York has not provided any dates for these deaths, so we’re unable to backfill them into the correct weeks. Based on average reporting from the state in January, it is likely that up to about 600 of these deaths took place recently. This suggests that the state’s audit has to date revealed approximately 5,000 deaths associated with outbreaks in nursing homes and assisted-living facilities that the state had previously declined to attribute to those outbreaks.

Meanwhile, a peer-reviewed study of more than 13,000 U.S. nursing homes published this week in JAMA Network Open suggests that nursing homes with the highest proportions of nonwhite residents experienced COVID-19 death counts that were more than three times higher than those of facilities with the highest proportions of white residents.

The testing decline we’re now seeing is almost certainly due to a combination of reduced demand as well as reduced availability or accessibility of testing. Demand for testing may have dropped because fewer people are sick or have been exposed to infected individuals, but also perhaps because testing isn’t being promoted as heavily.

The resolution of holiday reporting backlogs also almost certainly produced an artificial spike in the number of tests reported in early January—which means the decline we’re seeing now looks particularly dramatic when measured against that postholiday spike.

Bar chart showing daily U.S. COVID-19 reported tests, overlaid with seven-day average line. Tests have declined in recent weeks from their peak in early January.

Even if we adjust for holiday effects and estimate that we’re really testing only 1 million fewer people each week than we did a month ago, that’s unequivocally the wrong direction for a country that needs to understand the movements of the virus during a slow vaccine rollout and the spread of multiple new variants.

According to public-health experts, we’re also still not doing enough testing, —and we weren’t doing enough even at the January testing peak. Back in October, the Harvard Global Health Institute and NPR released testing targets that set a national target of about 2 million PCR tests a day. If we discount holiday effects, the United States finally hit that target in the week ending January 20, when states reported about 14 million tests—though the number immediately began dropping. But the HGHI test targets were based on October 1 case counts, and even after weeks of declines, we’re seeing more than twice as many new cases a day now as in early October. Vaccinations are only one component of the effort to get the pandemic under control and prevent another devastating surge. We need to be testing at our full capacity—and increasing that capacity—to keep eyes on the pandemic as we move into spring.

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