Wood House 76

We STILL don’t know for sure.

One explanation I keep hearing for the New York City’s staggering spring 2020 (figure 1, below) is, “Cuomo sent covid+ hospital patients into nursing homes and killed everyone.”¹

Unfortunately, this claim isn’t as well-substantiated as people believe it is. In truth, despite scads of media attention and Cuomo’s resignation, we still don’t know how many New York City nursing home residents died in those weeks. This might surprise anyone who followed the nursing home scandal, and/or otherwise believes state comptroller Tom DiNapoli’s March 2022 audit sufficiently addresses what happened and how many died.

Therefore, in series of Substack posts, I’ll attempt to expose some of the data discrepancies, chronological conflicts, and plot holes in The New York Nursing Home Narrative, especially with respect to New York City.

My first post (this one) is focused on relevant federal and state morality data for New York City. Subsequent articles will build on the data and incorporate policies, advisories, executive orders, and other documents or accounts. CORRECTION ADDED 10 MARCH 2026: This was actually my second article dedicated to the topic. The first was “Reconcilable Differences?”.

Where New Yorkers Died

We know where New York resident deaths in spring 2020 occurred because all U.S. death certificates list place of death as one (and only one) of eight options:

• Healthcare – (Hospital) Inpatient,
• Healthcare – Outpatient/Emergency Department
• Healthcare – Dead on Arrival
• Nursing Home/Long-Term Care Facility
• Hospice Facility
• Decedent’s Home
• Other² 
• Unknown

Place of death statistics for all states and counties are available via CDC WONDER, the U.S. federal mortality data warehouse.

The table below shows place of death for NYC residents who died of any cause in weeks 12-22 of 2020, compared with the same weeks in 2019:

Table 1

Looking at the sheer number of deaths in those 11 weeks — nearly 38,000 — we see far more people died in hospitals and in the decedent’s own home than died in nursing homes & long-term care facilities. Of the ~27,000-death increase, over 60% occurred in hospitals (inpatient, primarily) and 20% at home. Deaths in nursing homes/long-term care facilities make up a lower share of the spike, at 18%. Both the graph below – and one I posted on Twitter [now inserted as figure 3 ] – show hospital inpatient deaths rose fastest and most steeply, and took longer to fall back to baseline than deaths at home or in nursing home facilities.

Figure 2

Figure 3

But the total number of NYC residents that WONDER shows died in nursing homes (n=6,642) is a minimum; it is not equivalent to the number of all nursing home residents who died in these weeks. Some residents were transferred to hospitals and died there; others may have been transferred to hospice facilities, or home to where a spouse lived. 

To date, I’ve been unable to identify a federal data source that reports the weekly, monthly, or annual number of all-cause deaths among nursing home residents, including by place of death.

Where New York City Covid+ Nursing Home Residents Died

Neither New York State nor New York City has released data that shows how many all-cause nursing home resident deaths occurred in 2020 or thereafter. The best we have is the New York Department of Health’s Health Data New York (HDNY) Statewide COVID-19 Nursing Home and Adult Care Facility Fatalities file, initially published in October 2021. 

This dataset reports the number of weekly covid-related deaths that occurred among residents, whether those deaths occurred at the nursing home facility or in hospitals. Specifically, the file shows.

• Lab-confirmed positive covid-19 fatalities that occurred at each facility during the reporting week
• Presumed positive covid-19 fatalities that occurred at each facility during the reporting week.³
• Lab-confirmed positive covid-19 fatalities that occurred outside of each facility during the reporting week.

For spring 2020, nursing home facilities in New York City reported a total 5,395 resident covid-related deaths. (Table 2 below.) This includes 3,284 in-facility deaths and 2,111 confirmed covid+ deaths outside the facilities.⁴

Table 2

I wish I could say definitively what percentage these 5,395 deaths are of all NYC covid-attributed deaths, but federal, state, and city agencies all show different numbers. Based on those sources, shown below in figure 4, it looks like nursing home resident covid deaths comprise between 20%-30% of all deaths credited to the virus.

Figure 4

Where the Discrepancies Lie: WONDER vs. HDNY

Comparing to place of death stats in WONDER to the HDNY totals for NYC covid+ deaths among nursing home residents reveals discrepancies.

For deaths occurring in nursing home facilities, WONDER shows 2,293 of the 6,642 (34%) deaths that occurred in nursing homes/LTCFs have covid-19 on the death certificate, with 1,787 (26%) of those identifying covid-19 as underlying cause of death.

table

WONDER also shows the majority of deaths occurring in nursing homes — 65% (4,349) — do not list covid as an underlying or contributing cause. That’s interesting, because HDNY data suggests the percentage is closer to 51%.⁵

Whichever source is more accurate, it is worth noting both are saying the majority of deaths occurring in nursing homes in spring 2020 did not involve a positive covid test or determination that the virus contributed to death. This conflicts with public perception that covid is on the death certificates of most NYC residents who died in nursing homes during “lockdown”.

The sources also don’t appear to agree about the number of covid-related deaths in nursing home facilities. (Figure 5)

Figure 5

HDNY’s total for confirmed + presumed covid deaths is 1,000 deaths higher than the total WONDER shows have covid anywhere on the death certificate. The number of confirmed+ covid deaths per HDNY (n=1,341) is in the general ballpark of the number of deaths WONDER says identified covid as underlying cause, but is still “off” by ~450.

The most trustworthy number in the above graph is the 6,642 total all-cause deaths that occurred in nursing homes. New York officials need to publicly explain the disagreement between their data and WONDER on covid/non-covid deaths in those facilities.

What about nursing home residents who died in hospitals?

As mentioned previously, there is no public data source for weekly all-cause New York nursing home resident mortality in this (or any) period. So again, we turn to the data we do have from WONDER and HNDY.

HDNY data are suggesting that 61% of covid-positive deaths among nursing home residents occurred in the nursing home facilities, and a maximum of 2,111 of nursing home residents had a confirmed covid-positive death in a hospital.⁶

WONDER shows a total of 22,447 deaths from all causes occurred in NYC hospital inpatient/ED/outpatient in these weeks — a 285% (16K+) increase over the same weeks in 2019. (Table 3)

WONDER & HDNY data indicate that at least a quarter of the city’s eleven-week 27,000-death increase was nursing home residents. But the percentage may be much higher, given that neither the state nor city has released all-cause resident mortality data.

The bottom line is this:

Nearly three years later, we still don’t know how many New York City nursing home residents died in one of the deadliest mortality events the city has ever experienced.

We do know nursing home facilities saw fewer deaths than hospitals did, but not how many nursing home residents total died in hospitals.

To be continued…

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1. In all of my posts, New York City refers to the combined total of Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island) Counties. ↩︎
2. “Other” includes places like train tracks, a friend’s house, a car, etc. It’s possible some doctors or coroners who complete death certificates categorize rehab/transitional care facilities as “Other.” A friend of mine noted this occurring on her uncles’s death certificate from several years ago. ↩︎
3. Per my correspondence with HDNY, these are deaths that involving a positive test before death, but not after death. I was also told the presumed classification is not linked to the death certificate. ↩︎
4. Important notes about the data, per the data file dictionary and a HDNY staff health email response to me: a) The data source is the daily COVID-19 survey through the New York State Department of Health’s Health Electronic Response Data System (HERDS). b) Hospitals, nursing homes, and adult care facilities are required to complete this survey daily. c) Hospitals began reporting for the HERDS COVID-19 survey in [late] March 2020, while Nursing Homes and Adult Care Facilities began reporting in April 2020. d) Fatalities related to covid-19 disease that occurred prior to the first publication date are included. e) Data is reported by each facility and had not been verified for accuracy. ↩︎
5. Method: Divide the 6,642 total deaths from all causes WONDER shows occurred at nursing homes by the 3,284 confirmed + presumed covid deaths HDNY says occurred in nursing homes. ↩︎
6. Method: Divide the 3,284 confirmed + presumed covid deaths HDNY says occurred in nursing homes during the week of interest by 5,395, the total number they show occurredboth in the facilities and out of the facilities. ↩︎