ST. LOUIS — Dozens more long-term care facilities in the St. Louis region reported COVID-19 outbreaks to the state over the last three weeks as some local officials expressed frustration with the state’s refusal to publicly name the facilities.
From May 1 to Friday, the number of outbreaks at nursing homes and senior living communities in the region increased from 70 to 115, according to figures reported by the Missouri Department of Health and Senior Services.
Statewide, 176 certified long-term care facilities have reported outbreaks. About 65% of those are in the St. Louis area.
The increase comes as the state began requiring facilities with at least one confirmed case of COVID-19 — either among residents or staff employees — to report an outbreak. At the beginning of the month, only facilities with at least two cases were required to report to the state.
Missouri health officials repeatedly have said they will not name the facilities, citing privacy concerns. On Wednesday, DHSS Director Dr. Randall Williams said the increase has not made him reconsider that decision.
“Legally we are not allowed to release the names of the facilities. For us it’s not a choice,” Williams said.
Williams said the increase was not unexpected because employees can get infected through community transmission and then spread the disease at work. Those cases might not show up for two weeks.
“We always know, unfortunately, that they are probably going to be a lagging indicator,” Williams said.
Earlier this month, DHSS denied an open-records request by the Post-Dispatch for the names of facilities experiencing COVID-19 outbreaks, citing a state statute governing patients’ medical records that “prevents the identification of patient, physician, or medical facility.”
“This medical record information includes information obtained by the Missouri Department of Health and Senior Services as a result of conducting epidemiological studies to promote and safeguard the health of the citizens of Missouri, such as the COVID-19 pandemic,” DHSS spokeswoman Lisa Cox said in a written email.
Dave Roland, director of litigation for the Freedom Center of Missouri, said Missouri state statutes don’t clearly prohibit the department from naming facilities with COVID-19 outbreaks.
“When I look at this statute, it says they have to keep patient medical records confidential,” Roland said. “Identifying the care facilities that have identified cases of COVID-19 doesn’t require releasing any patient records. I think that they can absolutely identify the facilities without violating this statute.”
The Sunshine Law, Missouri’s open records law, requires exceptions for open records to be narrowly construed, he said.
“If there is doubt you should err on the side of transparency, not on the side of withholding information,” Roland said.
Identifying facilities battling COVID-19 could help direct more donations and support to those facilities, said Marjorie Moore, with VOYCE, a Creve Coeur-based nonprofit organization that advocates for long-term care residents in the St. Louis region.
“It doesn’t just allow us just to make sure our family members are going to places that are safe,” Moore said. “It also helps us provide donations and extra support to facilities that need it. Places that are keeping quiet — those employees are struggling alone.”
St. Louis County, the largest county in the state, leads the state with 74 facilities reporting outbreaks by May 22, up from 46 nursing at the beginning of the month. That accounts for more than half of the county’s long-term care facilities.
The St. Louis County Health Department’s data on COVID-19 deaths in nursing homes also often is lagging or incomplete because the facilities are required to report COVID-19 deaths to the state and not the county, Sara Dayley, a spokesperson for the department, said in an email earlier this month.
County Councilman Tim Fitch, R-3rd District, said county health officials aren’t being provided the names of facilities reporting COVID-19 or other details.
“How do we develop strategy on our response to this virus if we don’t know where it’s happening and why it’s happening?” he asked. “It’s frustrating to not be able to get very basic information and make some decisions.”
Eureka Mayor Sean Flower said Wednesday that he’s been frustrated with the lack of transparency on COVID-19 in nursing homes in the state. Flower said he recently found more than 70% of his area’s COVID-19 cases were within nursing homes, but he needed to call each facility to collect accurate data.
“The fact that even I have a hard time finding how many cases or deaths are in nursing homes here is unacceptable in a public health crisis,” Flower said. “How can we or the public know if we’re spending money and resources in the right places or not?”
When a long-term care facility reports a COVID-19 case, DHSS contacts them with testing recommendations and asks them to report to their local public health agency, Cox said. The department issued an order May 18 requiring facilities to report within 24 hours a positive COVID-19 test on a resident or employee to DHSS and their local health authority, if the local agency requires it.
Nationwide, the New York Times reports that more than a third of COVID-19 deaths have been linked to long-term care facilities, according to available data. The Times reports that in 14 states, long-term care residents and staff have accounted for more than half of all deaths from the virus.
Other states have been more transparent, releasing facility names along with their death and case counts. State officials in Illinois, for example, began releasing that information April 19.
In the Metro East counties of Madison, Monroe and St. Clair, there have been at least 94 COVID-19 deaths at 17 nursing homes, accounting for more than 60% of the deaths caused by the disease in those counties. The state’s database identifies each of those facilities affected by the coronavirus.
Many in the St. Louis area have also complained of difficulty getting information about loved ones living inside facilities where the virus has spread, including Cyndi Niehoff, who called to check up on her mother at Frontier Health & Rehabilitation March 29 only to learn she had died after testing positive for COVID-19 two days earlier.
The transparency problem was not unique to Missouri. Facing mounting pressure, on April 19, the Centers for Medicare and Medicaid Services began requiring uniform COVID-19 reporting in nursing homes nationwide. But, as of Wednesday, the agency had not yet released the reports.
The CMS rules also required facilities to inform residents and their legally designated family contact within 12 hours of either confirmation of a COVID-19 case or an incident of at least three residents or staff showing respiratory symptoms within 72 hours of each other. The homes also now have to provide weekly updates.
Here are totals for the facilities with at least one COVID-19 case in each St. Louis-area county:
St. Louis County: 74 out of 145 facilities (51%)
St. Louis: 17 out of 47 facilities (36%)
St. Charles County: 14 out of 42 (33%)
Franklin County: Five of 24 (21%)