The new coronavirus is racing through America's nursing homes, and the impact has been far greater than the federal government has said.

At least 2,300 long-term care facilities in 37 states have reported positive cases of COVID-19, according to data USA TODAY obtained from state agencies. More than 3,000 residents have died.

The numbers eclipse those previously disclosed by the Centers for Disease Control and Prevention (CDC), which in late March estimated that 400 facilities had reported cases of the virus. But the new totals still represent an incomplete accounting due to the ongoing lack of widespread testing for the virus and inconsistent record-keeping from state to state. On the federal level, neither the CDC nor the Centers for Medicare and Medicaid Services is tracking the number of U.S. nursing homes with COVID-19 cases, or the number of total cases and fatalities in those facilities.

In an effort to come up with a more accurate tally of how COVID-19 is affecting nursing homes and its staff and residents, USA TODAY requested that data from all 50 states. Six states did not respond, including Florida, a retirement haven. Another six states said they were compiling numbers but declined to provide some or all of them. Thirteen states could only provide partial data, citing various reasons including that they were not tracking deaths specifically in nursing homes or couldn’t separate staff and residents who have tested positive.

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The fact that so many states and the federal government are failing to track how COVID-19 is affecting a population known to be especially vulnerable to the virus is a problem, according to experts who said collecting data specific to nursing homes is vital for officials to navigate the current crisis, and for mitigating future outbreaks.

"The ultimate risk is potentially more infections and more deaths," said Kelly Reynolds, a professor of environmental microbiology at the University of Arizona who has studied infection control in health facilities.

About 1.3 million people live in the nation’s 15,600 nursing homes, according to the CDC. And most nursing homes have had problems managing infections even when there is not a pandemic.

Seventy-five percent of U.S. nursing homes have been cited for failing to properly monitor and control infections in the past three years, according to a USA TODAY analysis of federal inspection data published last month. Those citations have been as mild as a paperwork problem and as serious as failing to inform state officials that unmonitored workers had spread disease to patients in an outbreak.

The first U.S. outbreak of COVID-19 happened in a Washington state nursing home where dozens have died, and the virus has continued to ravage similar facilities since. Such facilities are now considered "an accelerator" of COVID-19, the Centers for Medicare and Medicaid Services said earlier this month.

A Maryland nursing home reported a single case of COVID-19 in late March — and 64 cases the next day. In Pennsylvania, administrators at a nursing home outside of Pittsburgh last week said they would shift away from testing residents and presume all were positive. In Massachusetts, the Department of Justice has opened an investigation at a nursing home for veterans where 32 have died.

"It’s a pretty tragic situation," said Greg Kelley, president of SEIU Healthcare Illinois Indiana Missouri & Kansas, a union that more than 91,000 workers. "And I don’t believe that the public fully understands the depth of the challenge right now."

The data gathered by USA TODAY illuminates the rapid and destructive spread of the virus: roughly half of the 41 COVID-19 deaths in Iowa were long-term care residents; more than half of the nursing homes in New York state have at least one positive case; the number of affected facilities in New Jersey swelled from 159 to 285 over four days last week.

More than 18,300 people across 26 states’ nursing homes have tested positive for COVID-19, the numbers show. Most of those individuals are residents, while some states provided a number that also encompassed staff.

On Saturday, the American Health Care Association and National Center for Assisted Living issued guidance to its members, recommending facilities report every positive COVID-19 test result to the state and notify all residents, families and staff when the first case is confirmed. The organization said it hopes federal agencies will use the data to target resources and testing.

"Without testing it will be hard to keep state and federal agencies apprised of how this virus is spreading and get the help facilities desperately need," said Mark Parkinson, the organization’s president and CEO.

'It changes rapidly’

The incomplete picture of what is currently known about COVID-19 in nursing homes comes from a patchwork of data collected at the local and state level. A spokeswoman for the Centers for Medicare and Medicaid Services said nursing homes are required to follow their local and state reporting requirements, but she did not respond to questions about why the agency is not tracking the number nationally. CDC spokesman Scott Pauley said the agency used “informal outreach” to state health departments late last month to estimate that 400 nursing homes had positive cases. The number has not been updated.

"The CDC doesn’t necessarily need to track them," Pauley said. "Each state is tracking their own."

USA TODAY found that is not the case. And the way states are tracking cases and deaths in nursing homes — if they are doing so at all — varies.

In some states, such as Washington and Louisiana, nursing homes are required to report straight to the state when a resident or employee tests positive for the virus. In others, such as New Jersey, that information flows through county health departments.

Several states said compiling accurate data has been a challenge.

"This information is not consistently entered into our reporting system by local health departments, and we don’t currently have the infrastructure within that system to collect the information and report it out," Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services, said in an email.

Seven states said they are actively working to improve the data they collect and provide to the public.

Each day, Virginia reports on the number of facilities with outbreaks but said it is in the process of building a tool to track other data, including deaths. South Carolina said it doesn’t require reporting of positive cases from nursing homes but that the state's epidemiologists "are working to investigate and compile this information." Arizona began requiring nursing homes to report positive cases to the state this week, under the terms of an executive order from the governor.

The Washington State Department of Social and Health Services — which provided USA TODAY with the number of affected facilities and deaths in those facilities — said one of the challenges is that the number of cases is an evolving snapshot in time.

"It changes rapidly," said Candace Goehring, the department’s director of residential care services. "By the time we get it and then we respond within 48 hours, it's changed."

'We were already in crisis’

Six states said they were tracking information on nursing home cases and deaths but not releasing some or all of it, raising questions about transparency.

New Hampshire said it would release information only "if it further ensures the health and safety of the public" and suggested reaching out to individual nursing homes. Georgia wouldn’t provide the number of people who had tested positive. Ohio would only release positive cases – 297 as of April 8 – but not deaths or the number of facilities affected, though it is tracking both.

Earlier this month, two Democratic U.S. senators, Bob Casey of Pennsylvania and Ron Wyden of Oregon, sent a letter to the head of the Centers for Medicare and Medicaid Services demanding that the agency release a full list of affected nursing homes.

"At a time when this information could be vital to the health and safety of Americans, it is imperative that the list of facilities with a COVID-19 case, among residents and staff, be made public and shared with relevant health care providers, authorities and Congress on a real-time basis," they wrote.

In some states where the names of affected facilities have not been released, the lack of transparency has trickled down to the facilities themselves.

In Illinois, where the state said it was not disclosing the names of facilities "to protect the resident's private health information," two certified nursing assistants told USA TODAY that they weren’t informed of COVID-19 cases in their own workplaces.

Francine Rico, who has worked at Villa at Windsor Park for nearly 23 years, said she found out that a resident she had worked with had tested positive for COVID-19 from a co-worker who happened to take the call from the hospital where the resident was tested. She said her facility’s administrators were not upfront.

"I'm mad because we are frontline workers but we have been lied to," she said. "They put our lives on the line. They have put our residents' lives on the line."

Tainika Somerville said she, too, worked directly with a resident who tested positive for COVID-19 and later died. She said no one at the Bridgeview Health Care Center in Illinois told her she’d been in contact with someone who had it. Instead, she learned about it through news articles and social media.

Somerville said the nursing home was understaffed and lacked communication even before the coronavirus. She said the facility also lacked sufficient personal protective equipment. (Somerville was fired April 2. She and the union said she was terminated for delivering a petition to the nursing home administrator and for speaking out about the delay in being notified about a COVID-19 case, a lack of protective gear and other issues).

"We were already in crisis before the pandemic hit," Somerville said. "And since the pandemic hit, it has made it so much worse."

Bridgeview Health Care Center did not respond to USA TODAY’s request for comment. In a statement on its website, the facility acknowledged it has had several residents test positive for COVID-19. It said it has implemented procedures to protect residents’ health.

In a statement provided to USA TODAY, Villa at Windsor Park acknowledged a delay in notifying staff that a resident had tested positive and said it has suspended the facility’s administrator while it conducts an investigation.

Kelley, the union president, said Rico and Somerville’s frustrations are shared by many workers the union represents.

"They feel like they're in the dark, that they don't really know if they're in danger, if there are patients or residents there that are infected with COVID-19," he said. "They feel unprepared very often as it relates to PPE. They feel that they are just, you know, being sort of led to slaughter without proper protection."

Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living, said long-term care providers are doing all they can to reduce the risk of an outbreak and limit the spread of the virus. But he said they need more personal protective equipment.

Experts say that better tracking will mean that limited resources can be better deployed.

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said she was on a call Thursday with the state ombudsman in Connecticut and was impressed by how they are using their data. Connecticut is one of at least four states that regularly posts online the number of cases and deaths in nursing homes. Edelman said the state communicates every day with facilities that have a positive case, including asking about staffing levels and whether they need supplies.

"You can’t be intelligent as a government if you don’t know where it is," Edelman said.

Accurate data on nursing homes could become even more important as the pandemic stretches on, said Justin Lessler, an associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health. He said that Americans are currently trying to contain the spread with a "blunt hammer approach," but that the goal eventually should be targeting interventions towards the most vulnerable.

"Data and lots of testing and lots of awareness of the situation," he said, "is the key to get from the blunt hammer to the scalpel."

Marisa Kwiatkowski is a reporter on the USA TODAY investigations team, focusing primarily on children and social services. Contact her at mkwiatko@usatoday.com, @IndyMarisaK or by phone, Signal or WhatsApp at (317) 207-2855.

Tricia L. Nadolny is a reporter on the USA TODAY investigations team. She can be reached at tnadolny@usatoday.com or @TriciaNadolny.