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A new COVID-19 spike in long-term-care facilities emerged in the West and Northeast last week, with both regions reporting their highest numbers of new cases in the last six months. The Midwest and South saw a small downturn in new cases, which is promising, yet the week still saw the nation’s highest number of newly reported cases—51,574—in long-term-care facilities since we started collecting this data in May.

Nationally, deaths increased by 27 percent from last week. More than a third of long-term-care facility deaths were reported in the Midwest; Michigan, Illinois, and Minnesota each reported over 200 deaths. In the South, Texas reported the highest number of new deaths, with 360.

COVID-19 data reporting is still catching up from expected lags that occurred around Thanksgiving, as many state health departments shifted their reporting schedules or closed because of the holiday. These delays might make this week’s newly reported cases and deaths seem unusually high compared to the previous week. We expect the data reporting process from states to smooth out this week before another period of irregularity around Christmas.

The Northeast is beginning to see COVID-19 case increases reminiscent of that region’s devastating outbreaks at the beginning of the pandemic. The region’s recent 838 newly reported deaths is the largest increase since early June, and 38 percent of these deaths came from Pennsylvania. That state last week hit a six-month high in the number of recorded cases, with 4,970. That represented more long-term-care facility cases than any state in the nation except for California, which reported 5,075. Pennsylvania’s new cases doubled the previous week’s increase, but it’s possible that a post-Thanksgiving backlog is artificially inflating these numbers.

The COVID Tracking Project hasn’t been able to obtain current data about the number of people living in Pennsylvania’s long-term-care facilities. But if numbers have remained relatively constant over the past five years, we can estimate, based on a 2015 figure of residents in LTC facilities, that nearly 30 percent of people living in these environments have gotten COVID-19. Pennsylvania combines staff and residents in their long-term-care facility death counts, but based on an analysis of our dataset, we know that 99 percent of all COVID-19 deaths from LTC facilities are among residents. We estimate that nearly one in five Pennsylvania long-term-care residents who contracted COVID-19 has died. We’re also keeping eyes on Colorado, which recorded a six-month high for both cases and deaths. 

Last week, Minnesota reported their highest number of long-term-care facility cases and deaths to date. Unlike many other states, Minnesota’s information is not traceable at the facility level. At the beginning of the summer, when Minnesota was reporting that around 80 percent of their COVID-19 deaths were from long-term-care facilities, officials refused to report cases and deaths at specific nursing homes and other long-term-care facilities, citing privacy concerns. Though Minnesota does provide a list of facility names with current COVID-19 outbreaks, more granular data—like how many cases and deaths are occurring within each facility—is still not available.

Changes in reporting for long-term-care facilities

Long-term-care facilities report COVID-19 data through the CDC’s National Healthcare Safety Network (NHSN), and this week, NHSN announced changes to COVID-19 data definitions. These changes include the removal of “suspected” cases, and a shift from “confirmed cases” to “positive cases.” NHSN also said that positive cases can be determined either by a positive antigen test result in addition to the gold-standard PCR test. The changes are noteworthy because in July, the Trump administration started sending rapid antigen tests to nursing homes to regularly test residents and staff.

One problem: Antigen tests can identify a probable case, not a “confirmed case”, according to guidance provided by the Council of State and Territorial Epidemiologists. When cases classified as “suspected” are removed, it will be harder for the public to understand exactly what types of tests are being used in long-term-care facilities and how residents and staff are faring.

Long-term care and the new administration

On December 3, a collection of long-term-care advocacy organizations sent a letter to the Biden-Harris Transition COVID-19 Advisory Board asking the new administration to include individuals with expertise in aging and disability in COVID-19 related boards or task forces; the letter also asked the incoming administration to form a task force centered on COVID-19’s impact on long-term-care facilities. 

On December 10, the US Food & Drug Administration will hold a meeting of its Vaccines and Related Biological Products Advisory Committee to discuss Pfizer-BioNtech’s request for emergency use authorization for their vaccine. Shortly after,the CDC’s Advisory Committee on Immunization Practices will hold emergency meetings on December 11 and 13 to provide official recommendations for use of the Pfizer-BioNtech vaccine among the highest priority groups —healthcare workers and long-term-care facility residents and staff.

Thank you to the Long-Term Care COVID Tracker data collection team.

If you have questions or information to share, you can reach the Long-Term Care COVID Tracker team at [email protected].


Artis Curiskis is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.

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Jessica Malaty Rivera has an MS in Emerging Infectious Diseases and is the Science Communication Lead at The COVID Tracking Project.

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Sarah R. McLaughlin is volunteer at the COVID Tracking Project supporting various data visualization initiatives. She has a background in Epidemiology/Biostatistics and is currently working at a Boston-based SaaS company.


Kara Oehler is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.

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Aarushi Sahejpal is a Shift Lead on Long-Term Care and City Data at the COVID Tracking Project. She also studies International Relations & Data Science at American University


Sara Simon works on The COVID Tracking Project’s data quality team and is also a contributing writer. She most recently worked as an investigative data reporter at Spotlight PA and software engineer at The New York Times.


Peter Walker is Head of Marketing & Growth at PublicRelay and Data Viz Co-Lead at The COVID Tracking Project.


More “Long-Term Care” posts

Vaccines Begin to Arrive as Cases and Deaths Keep Rising: This Week in Long-Term Care COVID-19 Data, Dec 16

Cases are up and known deaths in long-term-care facilities are the highest they’ve been since late May.

What We Know—and What We Don’t Know—About the Impact of the Pandemic on Our Most Vulnerable Community

Residents of nursing homes and other long-term-care facilities suffered an outsized impact from COVID-19. And yet we still don’t know how big of an impact, because so much data is missing or incomplete. What we do know makes plain that we failed to protect this community—and at great cost.

Giving Thanks and Looking Ahead: Our Data Collection Work Is Done

While our work to compile COVID-19 data has concluded, we will continue to share research, analysis, and documentation in the months ahead. We are enormously grateful to the hundreds of volunteers who made this work possible.

By Erin Kissane & Alexis MadrigalMarch 8, 2021