Since early in the pandemic, the Pennsylvania Department of Health has released data by county about the number of Covid-19 cases and deaths in long-term care facilities of various kinds. I wrote previously about the situation in Chester and Delaware County, where (at the time) long-term care facilities accounted for the vast majority of Covid-19 cases (88%, in the case of Chester County). The proportion is a little lower now (72% as of May 22). That drop in percentage is because cases are now increasing at a slower rate in long-term care facilities than in the rest of the population. 

When I wrote about this topic previously, Pennsylvania was not releasing data about cases and deaths at specific facilities. Now, that data is available on the Department of Health website. The current list (dated May 22) covers over 500 different facilities in 46 counties. In Chester County, 40 facilities with 669 patients/residents are listed. Kendal is listed but Crosslands (for unexplained reasons) is not. Kendal’s listing shows no resident cases of Covid-19 and “fewer than 5” among the staff.

Covid-19 cases in long-term care are frequently fatal. One aspect of this data that struck me in particular was how common death from Covid-19 is in these facilities, on average. Here in Chester County, there have been 167 Covid deaths in long-term care. In this county, an average of roughly 25% of long-term-care Covid cases are apparently fatal, based on the current data. (It’s unclear where this percentage is headed once we have better data—it could be too high because limited testing missed a lot of cases, or it could be too low because some current cases will result in deaths.)

But that isn’t the whole story. If you look at the details for individual facilities in Chester County, you will find that the rate of death is far from uniform. In two facilities, deaths occurred in over 50% of cases. But many facilities (some with as many as 31 cases) report no deaths at all. In fact, just 3 facilities account for more than half of the county’s 167 long-term-care deaths.

Chester County may be an extreme case, but a similar pattern holds throughout southeastern Pennsylvania. In Lancaster County, our neighbor to the west, just 3 facilities account for 78 of 160 deaths. In Delaware County, to the east of us, 7 facilities account for 208 of 400 deaths. And even in Philadelphia, with 59 long-term care facilities, just 8 of them account for 200 of the 382 deaths reported there.

A handful of hotspots dominate the data. Looking at Covid-19 cases in the general population of our area and in the area’s long-term care facilities, the global picture that emerges from the data is this: a handful of long-term care facilities have been hotspots for Covid-19 cases and fatalities; and because of them, long-term care facilities have dominated the Covid-19 statistics here. But buried in the statistics is the much larger number of long-term care facilities that are handling the pandemic very well.

This is important information because it changes how local pandemic information should be viewed. If outbreaks had been controlled in the hotspots, such as the 21 facilities mentioned in the last few paragraphs, the statistics would have changed dramatically. That is starting to happen now. Health-care professionals are learning to keep Covid-19 at bay in most long-term care facilities.

By applying the lessons learned from the pandemic so far, perhaps Covid-19 can be controlled at all of these facilities, and the emergence of new hotspots among them can be prevented. If so, the fight to control Covid-19 may shift to a different challenge: controlling infection in the public at large.