Additional Data Needed to Inform the COVID- 19 Response in Community Living Centers (GAO-21-369R)
Summary
A GAO report to congressional addressees, GAO-21-369R, dated June 10, 2021, on VA health care. It concerns the 134 community living centers (CLC) owned and operated by the Department of Veterans Affairs, where around 9,000 veterans per day received nursing home care in fiscal year 2019. CLCs are associated with VA medical centers and provide short-term rehabilitation, respite care, hospice care, long-term skilled nursing and dementia care, among other services. Its title states that additional data are needed to inform the COVID-19 response in CLCs.
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441 G St. N.W.
Washington, DC 20548
June 10, 2021
Congressional Addressees
VA Health Care: Additional Data Needed to Inform the COVID-19 Response in Community
Living Centers
Thousands of veterans rely on nursing home care provided or paid for by the Department
of Veterans Affairs (VA) to help them meet their skilled nursing and personal care needs. 1
Many of these veterans—around 9,000 per day in fiscal year 2019—receive this care in
one of 134 community living centers (CLC). 2 In contrast to the other nursing home settings
in which veterans may receive nursing home care, CLCs are owned and operated by VA
and are associated with, and may be located in, on the campuses of, or near, VA medical
centers (VAMC). 3 CLCs provide nursing home care that includes short-term rehabilitation,
respite care, hospice care, long-term skilled nursing, mental health recovery, dementia
care, and care for spinal cord injuries and disorders to veterans in this setting.
VA’s management of the Coronavirus Disease 2019 (COVID-19) pandemic for CLCs is of
critical importance. COVID-19 is a new and highly contagious respiratory disease causing
severe illness and death, particularly among the elderly. 4 Because of this, the health and
safety of the nation’s nursing home residents—often in frail health and living in close
proximity to one another—has been a concern. One of the first major outbreaks of COVID-
19 reported in the United States occurred in a Washington State nursing home in February
2020. Since then, there has been a rapid increase in the number of COVID-19 cases in
U.S. nursing homes, with more than 130,000 nursing home resident deaths reported as of
March 2021—which is likely an undercount. 5 Nursing home staff, who have close and
1VA is required to provide nursing home care for two categories of veterans, known as mandatory veterans: (1)
veterans who require nursing home care because of a service-connected disability, and (2) veterans who require
nursing home care and who also have a service-connected disability rated at 70 percent or greater. A service-
connected disability is an injury or disease that was incurred or aggravated while on active duty. Additionally, VA may
provide nursing home care to other veterans, on a discretionary basis, as capacity and resources permit. See 38
U.S.C. §§ 1710, 1710A.
2U.S. Department of Veterans Affairs, FY 2021 Budget Submission: Medical Programs and Information Technology
Programs, vol. 2 of 4 (February 2020).
3In addition to providing nursing home care to veterans in CLCs, VA pays for such care for veterans in two other
settings: public or privately owned community nursing homes and state-owned and -operated veterans homes.
VAMCs provide two or more categories of care to veterans, such as inpatient, outpatient, residential rehabilitation, or
institutional extended—that is, nursing home—care.
4SARS-CoV-2 (Severe Acute Respiratory Syndrome, coronavirus 2) is the virus that causes COVID-19. We refer to
SARS-CoV-2 as “the virus” throughout this report.
A. Patel and D.B. Jernigan, “Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel
Coronavirus Outbreak—United States, December 31, 2019–February 4, 2020,” Centers for Disease Control and
Prevention, Morbidity and Mortality Weekly Report, vol. 69: 140–146 (2020).
5Centers for Medicare & Medicaid Services, COVID-19 Nursing Home Data (Submitted Data as of Week Ending
Page 1 GAO-21-369R VA CLC COVID-19 Data
personal day-to-day contact with at risk residents, may also be at elevated risk for either
contracting COVID-19 while working in these facilities or transmitting the virus to
residents. 6 Given the risk COVID-19 poses in nursing homes, VA issued guidance specific
to its CLCs on virus mitigation and criteria for making operational decisions to protect
residents and staff. 7 Further, VA has also issued guidance on national surveillance—that is,
data collection and reporting—of COVID-19 case growth across the VA health care system,
among other measures, to inform resource allocation, maximize clinical care, and predict
future trends during the pandemic. 8
In August 2020, we began work reviewing VA’s response to the COVID-19 pandemic in CLCs
under the CARES Act provision that GAO monitor the federal response to the pandemic. 9 In this
report, we examine the extent to which VA has data on COVID-19 cases and deaths among
CLC residents and staff. Future GAO work will address more broadly selected CLCs’
experiences responding to the pandemic and VA’s oversight of this response.
To examine this issue, we interviewed VA officials about the data that VA has on COVID-19
cases and deaths among CLC residents and staff, including officials from VA’s Healthcare
Operations Center; Office of Geriatrics and Extended Care; and Office of Reporting, Analytics,
Performance, Improvement, and Deployment. Further, we analyzed the available facility-specific
data that VA had on COVID-19 cases and deaths among CLCs as of February 2021 and
calculated cumulative case rates and cumulative death rates. 10 We evaluated the available data
3/14/2021), accessed March 31, 2021, https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/.
We reported in September 2020 that the Centers for Medicare & Medicaid Services’ (CMS) data on COVID-19 cases
and deaths among residents and staff in nursing homes may be an undercount, because they do not capture the
early months of the pandemic. We recommended that the U.S. Department of Health and Human Services, in
consultation with CMS and the Centers for Disease Control and Prevention, develop a strategy to capture more
complete data on COVID-19 cases and deaths in nursing homes retroactive to January 1, 2020. See GAO, COVID-
19: Federal Efforts Could Be Strengthened by Timely and Concerted Actions, GAO-20-701, (Washington, D.C.: Sept.
21, 2020).
6See, for example, Kaiser Family Foundation, COVID-19 and Workers at Risk: Examining the Long-Term Care
Workforce, accessed January 6, 2021, https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-and-workers-at-
risk-examining-the-long-term-care-workforce/; and M. Keith Chen, J.A. Chevalier, and E.F. Long, “Nursing Home
Staff Networks and COVID-19,” Proceedings of the National Academy of Sciences of the United States of America,
vol. 118 (1): 1-7 (2021).
7See, for example, U.S. Department of Veterans Affairs Memorandum, Coronavirus (COVID-19) Community Living
Centers–Revised 03/17/20 (March 17, 2020); and U.S. Department of Veterans Affairs, Community Living Center
(CLC) Moving Forward Plan (July 27, 2020).
8U.S. Department of Veterans Affairs, Veterans Health Administration Moving Forward Plan: Safe Care is Our
Mission, April 30, 2020; and U.S. Department of Veterans Affairs Memorandum, National Surveillance Tool for
Veterans Health Administration (VHA) COVID-19 Operations (April 17, 2020).
Similarly, CMS requires that nursing homes participating in Medicare or Medicaid report data to the Centers for
Disease Control and Prevention on a weekly basis on confirmed cases of COVID-19 in residents and staff, among
other information. See 85 Fed. Reg. 27,550, 27,627 (May 8, 2020) (to be codified at 42 C.F.R. § 483.80(g)).
9Pub. L. No. 116-136, § 19010(b), 134 Stat. 281, 580 (2020). We regularly issue government-wide reports on the
federal response to COVID-19. For the latest report, see GAO, COVID-19: Sustained Federal Action Is Crucial as
Pandemic Enters Its Second Year, GAO-21-387 (Washington, D.C.: Mar. 31, 2021). Our next government-wide report
will be issued in July 2021 and will be available on GAO’s website at https://www.gao.gov/coronavirus.
10To determine the reliability of these data, we interviewed VA officials and reviewed a VA manual that defines the
data elements. VA officials indicated that the reported number of cases or deaths that occurred in previous months
might change over time as staff continuously update information—such as information on CLC residents who test
positive for the virus—in VA data systems. However, we found the data sufficiently reliable for our reporting.
Page 2 GAO-21-369R VA CLC COVID-19 Data
against Centers for Disease Control and Prevention (CDC) guidance and prior GAO work on
national surveillance of public health events, such as the COVID-19 pandemic, as well as
federal internal control standards related to risk assessment and information and
communication. 11
We conducted this performance audit from August 2020 through June 2021 in accordance with
generally accepted government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that the evidence obtained
provides a reasonable basis for our findings and conclusions based on our audit objectives.
While VA Has Facility-Specific Data on COVID-19 Cases and Deaths among CLC
Residents, It Does Not Have Such Data for CLC Staff
VA Has Had Facility-Specific Data on COVID-19 Cases and Deaths among CLC Residents
since November 2020
VA has facility-specific data—that is, data by individual CLC—on COVID-19 cases and deaths
among CLC residents to inform its response to the pandemic in this nursing home setting.
According to officials, VA had these data beginning in November 2020. Prior to that time, VA
only had CLC-specific data on the number of COVID-19 cases and deaths among all residents
nationwide, which, according to agency officials, the agency began to work to compile in June
2020 retroactive to March 1, 2020. 12 Officials told us that they were unable to compile reliable
facility-specific data until November 2020 because of challenges in classifying resident cases
According to VA officials, the available data includes information on residents who test positive for the virus as well as
residents diagnosed with COVID-19 without a test. Throughout this report, we include both instances when referring
to “COVID-19 cases” or “COVID-19 deaths” among residents.
VA categorizes cases and deaths by the location in which residents contracted the virus—within a CLC, external to a
CLC, or in an indeterminate location. We combined these categories for our analysis and report cases or deaths
collectively throughout this report.
VA officials told us that they compile data on deaths from any cause that occurred within 30 days of residents being
diagnosed with COVID-19 or testing positive for the virus. Thus, these deaths may be related to COVID-19 but are
not necessarily attributable to it.
We calculated cumulative case rates and cumulative death rates by dividing the cumulative number of cases or
deaths that occurred among CLC residents from March 1, 2020, through a given month by the cumulative number of
residents for the same period. While incidence rates may commonly be standardized by average daily census, VA
only provided cumulative counts of residents at the time of our analysis. As such, the reported rates represent the
best available information at the time.
Separate from the CLC-specific data that VA provided to us, VA reports data on the number of COVID-19 cases and
deaths among veterans and staff for each of its VAMCs on its website. See U.S. Department of Veterans Affairs,
Department of Veterans Affairs COVID-19 National Summary, accessed February 3, 2021,
https://www.accesstocare.va.gov/Healthcare/COVID19NationalSummary.
11Centers for Disease Control and Prevention, Updated Guidelines for Evaluating Public Health Surveillance
Systems, Recommendations from the Guidelines Working Group, Morbidity and Mortality Weekly Report 2001;50
(No. RR-13); GAO, COVID-19: Data Quality and Considerations for Modeling and Analysis, GAO-20-635SP
(Washington, D.C.: July 30, 2020); and Standards for Internal Control in the Federal Government, GAO-14-704G
(Washington, D.C.: Sept. 2014). Internal control is a process effected by an entity’s management, oversight body,
and other personnel that provides reasonable assurance that the objectives of an entity will be achieved.
12VA officials also indicated that, between April 2020 and August 2020, they reported data to VA leadership on the
number and rate of positive COVID-19 tests among residents by individual CLC. However, according to officials,
these data are not an indicator of the number or rate of COVID-19 cases among these residents.
Page 3 GAO-21-369R VA CLC COVID-19 Data
and deaths by individual CLC. 13 Since that time, they have compiled and reviewed the facility-
specific resident data on at least a monthly basis, according to officials. Officials stated that they
report these data to VA leadership if they determine that the data indicate a change to current
policy or practice related to the response to the pandemic in CLCs is needed.
Based on our analysis of the facility-specific resident data, we found that the five highest
cumulative case rates among individual CLCs ranged from 38 percent to 59 percent of total
residents, and the five highest cumulative death rates ranged from 6 percent to 11 percent of
total residents, for the period March 1, 2020, through February 14, 2021. In addition, five CLCs
experienced no cases of COVID-19 among residents, and 54 experienced no deaths among
residents. (See enclosure I for the complete facility-specific resident data.) These data also
show that the nationwide cumulative case rate—that is, the cumulative case rate among all CLC
residents—was 17 percent, and the nationwide cumulative death rate was one percent.
Our analysis of these data also indicates that, nationally, the number of new cases of COVID-19
among CLC residents peaked at 759 in December 2020. The next month, in January 2021, the
greatest number of deaths occurred among CLC residents with such a diagnosis. (See fig. 1.)
These data follow a similar overall pattern of increases and decreases over time as CDC data
on COVID-19 cases and deaths among community nursing home residents. 14
13According to VA officials, they began to test methods for reliably compiling facility-specific data prior to November
2020.
14We reported in March 2021 that new cases of COVID-19 among community nursing home residents began to
increase in late 2020, peaked in December of that year, and have since declined. Further, we reported that deaths
among residents with COVID-19 began to increase in late November, with changing death counts paralleling changes
in the country as a whole. See GAO, COVID-19: Sustained Federal Action Is Crucial as Pandemic Enters Its Second
Year, GAO-21-387 (Washington, D.C.: Mar. 31, 2021).
Page 4 GAO-21-369R VA CLC COVID-19 Data
Figure 1: Number of New Coronavirus Disease 2019 (COVID-19) Cases and Deaths among Department of
Veterans Affairs (VA) Community Living Center (CLC) Residents Nationwide and by Month, June 2020
through February 14, 2021
Note: VA officials indicated that the reported number of cases or deaths that occurred in previous months might change over time as
staff continuously update information—such as information on CLC residents who test positive for SARS-CoV-2 (Severe Acute
Respiratory Syndrome, coronavirus 2), the virus that causes COVID-19 (which we refer to as “the virus”)—in VA data systems.
According to VA officials, the data includes information on residents who test positive for the virus as well as residents diagnosed
with COVID-19 without a test. We include both instances in the numbers of new cases of COVID-19 or new deaths among those
with a COVID-19 diagnosis.
VA categorizes cases and deaths by the location in which residents contracted the virus—within a CLC, external to a CLC, or in an
indeterminate location. We combined these categories for our analysis and report cases or deaths collectively.
a
VA compiles these data by month, with the exception of the data for June 2020. According to VA officials, the data for that date
represent the number of new cases or new deaths that occurred between March 1, 2020, and June 30, 2020.
b
The data for February are through February 14, 2021, and do not represent the total number of new cases or new deaths for the
entire month.
VA officials told us that they compile data on deaths from any cause that occurred within 30 days of residents being diagnosed with
c
COVID-19 or testing positive for the virus. Thus, these deaths may be related to COVID-19 but are not necessarily attributable to it.
Page 5 GAO-21-369R VA CLC COVID-19 Data
VA Does Not Have Facility-Specific Data on COVID-19 Cases and Deaths among CLC Staff
For the first year of the pandemic, from March 2020 through March 2021, VA has not had
facility-specific data on COVID-19 cases and deaths among CLC staff that the agency could use
to identify regional or local trends in the pandemic. Because CLC staff have close and personal
day-to-day contact with residents, these data are of particular importance for preventing
transmission of the virus among both populations.
VA does not have facility-specific data on COVID-19 cases and deaths among CLC staff
because, according to agency officials, there are challenges to identifying such staff in existing
employee data on COVID-19. Officials told us that CLC operations are integrated with the
associated VAMC, the same as with any other department or unit of the medical center, and
VAMC staff are not necessarily assigned as dedicated staff to the CLC. 15 According to officials,
VA incorporates data on staff who worked at a CLC into the data it compiles and reports on
COVID-19 cases and deaths among all VAMC staff and it is difficult to separate out staff who
worked at a CLC in these data. Specifically, officials indicated that VA typically classifies or
codes staff by VAMC in the data but does not sub-classify or sub-code them by specific VAMC
care setting—such as a CLC. Among other options, VA could consider leveraging data that may
exist—such as laboratory test result data—related to the required COVID-19 testing of CLC staff
to identify the number of cases among these individuals. 16
VA’s lack of facility-specific data on COVID-19 cases and deaths among CLC staff is
inconsistent with CDC guidance on national surveillance of public health events. This guidance
recommends that officials should have data on public health events by specific populations and
by locality to develop appropriate responses. 17 GAO’s prior work also identified the importance
of reporting COVID-19 data by demographic group to highlight those disproportionally affected
by COVID-19 as well as by geographic location, as the pandemic has affected some areas of
the country more than others. 18 Further, federal internal controls require that agencies identify
and respond to risk and use quality information to achieve objectives. 19 The risk of contracting
or transmitting COVID-19 may vary based upon the location in which VAMC staff worked, be it
full time or part time, necessitating data specific to CLC staff to allow the agency to respond
appropriately.
Until VA has facility-specific data on COVID-19 cases and deaths for CLC staff, compiled
and reviewed on a regular basis and reported to leadership as needed, VA will not have
15VA guidance on the response to the COVID-19 pandemic recommends that dedicated staff be assigned to the CLC
to protect veterans and staff from acquiring the virus. See U.S. Department of Veterans Affairs Memorandum,
Coronavirus (COVID-19) Community Living Centers.
16VA guidance requires that CLCs test staff as soon as a new confirmed case of COVID-19 is identified in the CLC
and twice weekly thereafter until no new cases have been identified for a 14-day period. Further, this guidance
requires that staff be tested based on risk, including the risk posed by the prevalence of the virus in the community.
See U.S. Department of Veterans Affairs Memorandum, Guidance on COVID-19 Testing for Community Living
Centers (CLC) and Spinal Cord Injuries and Disorder (SCI/D) Units (December 3, 2020). Although these data may
not provide a complete picture of COVID-19 cases among CLC staff since testing is based on the occurrence of
outbreaks or risk, they could provide at least partial information on the situation in CLCs.
17Centers for Disease Control and Prevention, Updated Guidelines for Evaluating Public Health Surveillance
Systems.
18GAO-20-635SP.
19GAO-14-704G.
Page 6 GAO-21-369R VA CLC COVID-19 Data
complete information on the extent of the pandemic across its CLCs. As previously noted,
research has shown that staff are an important source of COVID-19 transmission to
nursing home residents. 20 Although VA officials told us that CLCs may informally report
outbreaks of COVID-19 to VA officials, inclusive of staff cases, VA could use facility-
specific staff data to better inform the agency’s national surveillance and respond
systematically to virus outbreaks. 21
These facility-specific data would allow VA to monitor the extent of morbidity and mortality
in CLCs individually, regionally, or nationally among both residents and staff; identify local
or regional trends in infection rates among both populations; and oversee whether CLCs
have taken appropriate steps to mitigate the spread of COVID-19 to protect both veterans
and employees in this nursing home setting, among other things. 22 VA could then better
allocate resources to CLCs when and where they are needed most, depending upon the
status of the virus’ spread in each individual facility. This type of surveillance is critical for
VA to manage not just the current pandemic but also future infectious disease outbreaks
among the vulnerable CLC population.
Conclusions
Veterans who receive nursing home care in one of VA’s 134 CLCs are at increased risk of
contracting COVID-19 and experiencing severe morbidity or mortality related to this disease.
CLC staff are also at elevated risk of contracting the virus or transmitting it to residents, given
the close and personal day-to-day contact they have with these veterans. Although VA now has
facility-specific data on the number of COVID-19 cases and deaths among CLC residents, the
agency does not have these data for CLC staff. These facility-specific staff data would provide a
more complete picture of the COVID-19 situation in CLCs, which VA could use to better inform
the agency’s response to the COVID-19 pandemic—or to future infectious disease outbreaks—
and target its response effectively.
Recommendations for Executive Action
We are making the following recommendation to VA:
The Department of Veterans Affairs Under Secretary for Health should compile and review
facility-specific COVID-19 data on Community Living Center staff cases and deaths on a regular
basis to inform the agency’s response to the pandemic or future infectious disease outbreaks.
(Recommendation 1)
Agency Comments
We provided a draft of this report to VA for review and comment. In its written comments, which
are reproduced in enclosure II, VA concurred with our recommendation in principle. VA agreed
20See again, for example, Kaiser Family Foundation, COVID-19 and Workers at Risk, and Chen, Chevalier, and
Long, “Nursing Home Staff Networks and COVID-19.”
21VA could use the facility-specific data to calculate the nationwide number of COVID-19 cases and deaths that
occurred among staff across all CLCs nationwide.
22We have reported similar effects related to the limited availability of data on the occurrence of COVID-19 in state
veterans homes and community nursing homes. See GAO, COVID 19: Federal Efforts Could be Strengthened by
Timely and Concerted Actions, GAO-20-701 (Washington, D.C.: Sept. 21, 2021), and COVID-19: Urgent Actions
Needed to Better Ensure an Effective Federal Response, GAO-21-191 (Washington, D.C.: Nov. 30, 2020).
Page 7 GAO-21-369R VA CLC COVID-19 Data
with the importance of tracking COVID-19 cases and deaths among its staff to inform the
agency’s response to the pandemic and prepare for future infectious disease outbreaks. VA
stated that it will provide periodic information to agency leadership on COVID-19 case counts
among CLC staff by September 2021 but noted that this information should not be used to
compare CLCs or CLCs and community nursing homes. VA reiterated that VAMC staff may be
deployed to different areas of the medical center based on need during the pandemic. Thus, the
agency indicated, while it can provide staff case counts, it is difficult to calculate accurate
COVID-19 case rates or death rates for specific VAMC unit staff, such as those working in
CLCs. Our recommendation focuses on the need for CLC staff data generally and does not
indicate that VA should calculate COVID-19 case rates or death rates for such staff specifically.
----
We are sending copies of this report to the appropriate congressional committees, the Secretary
of Veterans Affairs, and other interested parties. In addition, the report is available at no charge
on the GAO website at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me at (202) 512-7114 or
at SilasS@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. Major contributors to this report were Karin
Wallestad (Assistant Director), Karen Belli (Analyst-in-Charge), Kye Briesath, Naomi Joswiak,
and Jeffrey Tamburello. Also contributing were Laurie Pachter and Jennifer Whitworth.
Sharon M. Silas
Director, Health Care
Enclosures - 2
Page 8 GAO-21-369R VA CLC COVID-19 Data
List of Addressees
The Honorable Patrick Leahy
Chairman
The Honorable Richard Shelby
Vice Chairman
Committee on Appropriations
United States Senate
The Honorable Ron Wyden
Chairman
The Honorable Mike Crapo
Ranking Member
Committee on Finance
United States Senate
The Honorable Patty Murray
Chair
The Honorable Richard Burr
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
The Honorable Gary C. Peters
Chairman
The Honorable Rob Portman
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Jon Tester
Chairman
Committee on Veterans’ Affairs
United States Senate
The Honorable Rosa L. DeLauro
Chairwoman
The Honorable Kay Granger
Ranking Member
Committee on Appropriations
House of Representatives
The Honorable Frank Pallone, Jr.
Chairman
The Honorable Cathy McMorris Rodgers
Republican Leader
Committee on Energy and Commerce
House of Representatives
Page 9 GAO-21-369R VA CLC COVID-19 Data
The Honorable Bennie G. Thompson
Chairman
The Honorable John Katko
Ranking Member
Committee on Homeland Security
House of Representatives
The Honorable Carolyn B. Maloney
Chairwoman
The Honorable James Comer
Ranking Member
Committee on Oversight and Reform
House of Representatives
The Honorable Mark Takano
Chairman
Committee on Veterans’ Affairs
House of Representatives
The Honorable Richard E. Neal
Chairman
The Honorable Kevin Brady
Republican Leader
Committee on Ways and Means
House of Representatives
The Honorable Julia Brownley
Chairwoman
Subcommittee on Health
Committee on Veterans’ Affairs
House of Representatives
The Honorable Edward J. Markey
United States Senate
The Honorable Elizabeth Warren
United States Senate
Page 10 GAO-21-369R VA CLC COVID-19 Data
Enclosure I: COVID-19 Cases and Deaths among Community Living Center Residents
through February 14, 2021
Legend: We use “—“ to indicate instances in which there were one or two new cases or new deaths among CLC residents in a given
month. We blinded these instances to protect personal privacy.
Table 1: Coronavirus Disease 2019 (COVID-19) Cases and Deaths among Department of Veterans Affairs (VA)
Community Living Center (CLC) Residents by Month, June 2020 through February 14, 2021
CLC Location
State City June July Aug. Sept. Oct. Nov. Dec. Jan. Feb.
2020a 2020 2020 2020 2020 2020 2020 2021 2021b
AL Tuscaloosa New cases 7 — 0 — 0 13 15 4 —
New deaths 3 0 0 0 0 — 0 0 0
Case rate (%) 5.07 6.52 6.52 7.04 6.94 15.65 25.68 27.27 27.92
Death rate (%) 2.17 2.17 2.17 2.11 2.08 3.40 3.38 3.25 3.25
Tuskegee New cases — — 0 0 0 0 — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 3.57 5.36 5.26 5.08 5.08 5.00 7.94 9.38 9.38
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
AR North Little New cases 5 — 0 — — 4 11 18 5
Rock New deaths — 0 0 0 0 — — — 0
Case rate (%) 2.92 3.21 3.02 3.81 3.88 5.31 9.13 14.69 16.21
Death rate (%) 0.58 0.53 0.50 0.48 0.43 0.82 1.14 1.40 1.38
AZ Phoenix New cases — 24 5 — — 3 4 18 —
New deaths 0 0 — 0 0 — 0 — 0
Case rate (%) 1.11 9.92 10.20 10.16 10.25 10.62 11.30 15.59 15.65
Death rate (%) 0.00 0.00 0.34 0.33 0.31 0.59 0.56 0.81 0.80
Prescott New cases 0 — — 0 0 — 6 — —
New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.00 2.99 4.17 3.85 3.80 4.55 10.64 12.37 13.73
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 1.06 1.03 0.98
Tucson New cases 3 — 3 — 0 3 11 10 11
New deaths — — 0 0 0 0 — 5 3
Case rate (%) 1.36 2.02 2.66 2.98 2.65 3.09 5.33 7.14 9.07
Death rate (%) 0.45 0.81 0.66 0.60 0.53 0.48 0.67 1.68 2.22
CA Fresno New cases — 3 3 3 4 8 14 8 5
New deaths 0 0 0 0 0 — 3 0 0
Case rate (%) 1.11 3.92 6.03 7.69 9.66 13.17 18.85 21.46 22.58
Death rate (%) 0.00 0.00 0.00 0.00 0.00 1.20 2.62 2.44 2.30
Livermore New cases 17 — 0 — — — 0 — 0
New deaths — 0 0 0 0 0 0 0 0
Case rate (%) 17.00 17.82 17.82 18.45 18.35 19.09 18.26 18.80 18.80
Death rate (%) 2.00 1.98 1.98 1.94 1.83 1.82 1.74 1.71 1.71
Page 11 GAO-21-369R VA CLC COVID-19 Data
Loma Linda New cases — 3 — 3 — — 4 10 10
New deaths 0 0 0 0 0 0 0 4 0
Case rate (%) 0.63 1.94 2.02 2.90 2.87 3.24 4.37 7.27 9.94
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.16 1.14
Long Beach New cases 13 0 0 — 0 — 5 9 0
New deaths 0 0 0 0 0 0 — — 0
Case rate (%) 11.11 9.92 8.90 9.62 8.52 9.04 10.78 13.72 13.48
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.49 1.33 1.30
Los Angeles New cases 46 19 4 — 3 0 39 39 14
New deaths 3 0 0 0 0 0 0 3 —
Case rate (%) 19.57 24.44 24.04 23.26 23.17 22.05 31.11 37.10 38.37
Death rate (%) 1.28 1.13 1.05 1.00 0.95 0.91 0.83 1.47 1.86
Martinez New cases — 0 — 3 5 3 4 4 0
New deaths 0 0 0 0 — 0 0 0 0
Case rate (%) 1.22 1.12 1.55 2.69 4.55 5.49 6.82 7.91 7.72
Death rate (%) 0.00 0.00 0.00 0.00 0.41 0.39 0.38 0.36 0.35
Menlo Park New cases 4 0 — — — 0 — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 2.17 2.03 2.13 2.49 2.81 2.71 3.37 3.66 3.64
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Palo Alto New cases 0 0 — 0 0 0 0 — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 1.30 1.18 1.02 0.95 0.88 1.67 3.13
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
San Diego New cases 0 — — — 0 — — 5 0
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 0.00 1.39 2.44 4.12 3.81 4.27 5.56 9.45 9.16
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.57 1.53
San Francisco New cases 0 0 0 0 0 0 20 — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 16.13 16.67 17.05
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Sepulveda New cases 6 3 0 0 0 — 5 7 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 6.45 9.38 8.82 8.49 8.04 8.40 12.10 16.30 16.20
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CO Grand New cases 0 0 0 0 — — 5 5 0
Junction New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.00 0.00 0.00 0.00 1.54 2.60 7.87 12.24 11.21
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 1.12 1.02 0.93
Pueblo New cases 0 0 0 0 0 — 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 3.23 3.23 3.13 3.13
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 12 GAO-21-369R VA CLC COVID-19 Data
CT West Haven New cases — — — 0 0 0 5 3 —
New deaths — 0 0 0 0 0 0 0 0
Case rate (%) 2.94 3.61 4.12 3.57 3.15 2.90 6.43 7.84 8.44
Death rate (%) 1.47 1.20 1.03 0.89 0.79 0.72 0.71 0.65 0.65
DC Washington New cases 5 0 0 0 — — — 4 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 7.81 7.81 7.58 7.35 8.33 9.33 10.13 13.64 13.48
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
DE Wilmington New cases — 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 2.44 2.33 2.33 2.27 2.27 2.22 2.17 2.17 2.08
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
FL Bay Pines New cases 3 3 — 0 0 — 4 3 —
New deaths — 0 0 0 0 — 0 0 0
Case rate (%) 2.27 4.23 5.03 4.42 3.86 4.52 5.86 6.37 6.88
Death rate (%) 0.76 0.70 0.63 0.55 0.48 0.90 0.84 0.75 0.72
Gainesville New cases 3 — 3 — — 3 3 6 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 4.55 6.58 9.20 10.31 9.73 11.20 12.50 15.75 16.56
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Lake City New cases 5 7 19 3 — 7 8 8 3
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 3.13 6.86 15.42 15.38 14.89 16.73 19.01 20.28 20.82
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Miami New cases 16 5 6 — 3 — 0 5 0
New deaths — — — 0 0 0 0 — 0
Case rate (%) 13.01 16.03 18.00 18.24 17.98 17.09 16.43 17.65 17.11
Death rate (%) 0.81 1.53 2.00 1.89 1.69 1.51 1.45 1.81 1.75
Orlando New cases 3 4 — 4 3 — 8 6 4
New deaths 0 0 0 0 — 0 0 0 —
Case rate (%) 2.00 3.76 4.37 5.88 6.84 7.44 9.59 11.19 11.92
Death rate (%) 0.00 0.00 0.00 0.00 0.43 0.41 0.37 0.35 0.66
Tampa New cases — 5 8 — 3 — — 3 3
New deaths 0 5 4 0 — 0 — — —
Case rate (%) 1.79 4.76 9.26 8.65 8.92 8.55 8.27 8.66 9.31
Death rate (%) 0.00 3.40 5.56 4.86 4.69 4.27 4.33 4.69 4.83
West Palm New cases — 9 4 7 — — 3 5 —
Beach New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.96 7.87 9.79 13.29 12.85 13.02 13.73 14.60 14.23
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.49 0.44 0.42
GA Augusta New cases 0 0 0 0 — 4 5 8 —
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 0.00 0.00 0.00 0.00 1.63 4.88 8.66 14.18 14.93
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.75 0.75
Page 13 GAO-21-369R VA CLC COVID-19 Data
Carrollton New cases 0 — 0 0 0 0 11 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 2.38 2.38 2.38 2.38 2.38 28.57 30.95 26.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Decatur New cases 11 4 — 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 23.91 30.00 32.00 32.00 32.00 32.00 32.00 32.00 32.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Dublin New cases — — — 0 0 3 14 5 —
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 1.28 2.50 3.13 3.13 3.13 4.97 13.66 16.77 17.39
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.62 0.62
HI Honolulu New cases 0 0 0 0 0 — 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 1.39 1.37 1.37 1.35
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
IA Des Moines New cases 5 0 — — 5 7 7 9 4
New deaths — 0 0 0 0 0 0 — 0
Case rate (%) 2.84 2.45 2.55 2.60 3.95 5.78 7.30 9.14 9.95
Death rate (%) 0.57 0.49 0.43 0.37 0.33 0.30 0.28 0.52 0.51
ID Boise New cases 0 0 — 0 4 3 5 9 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 1.06 0.92 4.42 6.50 10.40 15.83 16.22
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
IL Chicago New cases 11 4 — — 6 11 15 13 —
New deaths 0 0 0 0 0 — 0 — 0
Case rate (%) 14.67 15.15 13.60 11.84 13.41 16.59 21.10 23.42 23.19
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.47 0.42 1.12 1.09
Danville New cases 0 0 0 3 27 — — 4 —
New deaths 0 0 0 0 7 0 0 0 0
Case rate (%) 0.00 0.00 0.00 2.52 25.00 26.67 27.87 31.15 31.97
Death rate (%) 0.00 0.00 0.00 0.00 5.83 5.83 5.74 5.74 5.74
Hines New cases 27 — — — 7 10 11 11 6
New deaths — 0 0 0 0 0 0 0 0
Case rate (%) 12.92 12.13 10.91 10.16 11.11 12.80 14.15 15.42 16.14
Death rate (%) 0.96 0.84 0.73 0.66 0.58 0.53 0.48 0.44 0.42
Marion New cases 0 0 0 6 5 — 4 3 —
New deaths 0 0 0 0 — 0 0 0 0
Case rate (%) 0.00 0.00 0.00 6.67 11.34 12.15 13.93 14.60 14.69
Death rate (%) 0.00 0.00 0.00 0.00 2.06 1.87 1.64 1.46 1.40
North Chicago New cases 26 4 — — 9 — 4 — —
New deaths — 0 0 0 — — 0 0 0
Case rate (%) 23.21 22.39 21.05 20.50 24.56 25.58 27.75 27.53 26.74
Death rate (%) 0.89 0.75 0.66 0.62 1.17 1.74 1.73 1.69 1.60
Page 14 GAO-21-369R VA CLC COVID-19 Data
IN Marion New cases 0 0 — — — 8 16 15 3
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.75 1.46 2.19 7.91 19.42 30.00 31.91
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
KS Leavenworth New cases 0 0 0 0 0 0 — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 2.70 5.13 5.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Topeka New cases 0 — 0 0 — 4 4 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 2.50 2.33 2.04 5.45 12.07 18.97 18.64 17.74
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Wichita New cases 0 0 0 0 0 0 — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 3.85 7.27 6.90
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
KY Lexington New cases — 0 — 0 — 3 3 6 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.98 0.79 1.41 1.29 2.42 4.19 5.65 8.51 9.28
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
LA New Orleans New cases 0 — — — — — 0 5 4
New deaths 0 0 0 0 0 0 0 0 —
Case rate (%) 0.00 1.11 1.79 2.42 2.80 3.68 3.51 5.91 7.61
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.51
Pineville New cases — — 0 3 — 9 0 — —
New deaths 0 0 0 0 — 0 0 0 0
Case rate (%) 2.90 4.29 4.29 8.11 9.09 20.25 20.25 20.99 21.69
Death rate (%) 0.00 0.00 0.00 0.00 1.30 1.27 1.27 1.23 1.20
MA Bedford New cases 108 — 6 — — 5 10 17 —
New deaths 33 0 0 0 0 0 0 0 —
Case rate (%) 35.29 32.84 32.49 31.38 30.20 30.10 31.68 33.86 33.63
Death rate (%) 10.78 9.85 9.24 8.78 8.38 8.01 7.80 7.40 7.47
Brockton New cases 44 0 3 — — 0 0 4 0
New deaths 4 0 0 0 0 0 0 0 0
Case rate (%) 30.14 25.43 23.27 21.78 20.24 18.73 17.79 18.12 17.42
Death rate (%) 2.74 2.31 1.98 1.78 1.62 1.50 1.42 1.34 1.29
Leeds New cases 0 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MD Baltimore New cases 11 — 0 22 3 — — — —
New deaths 3 0 0 3 0 0 0 0 0
Case rate (%) 9.57 10.00 9.16 25.37 27.61 28.36 28.37 27.63 28.39
Death rate (%) 2.61 2.50 2.29 4.48 4.48 4.48 4.26 3.95 3.87
Page 15 GAO-21-369R VA CLC COVID-19 Data
Perry Point New cases 0 — — 0 0 — 14 22 —
New deaths 0 0 0 0 0 0 — — 0
Case rate (%) 0.00 1.68 2.36 2.14 2.08 2.70 11.69 25.00 25.47
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.65 1.25 1.24
ME Augusta New cases 0 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MI Ann Arbor New cases 0 0 0 — 0 — — 3 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 1.14 0.93 1.67 2.50 5.00 4.55
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Battle Creek New cases 0 0 5 0 — — 0 — —
New deaths 0 0 — 0 0 0 0 — 0
Case rate (%) 0.00 0.00 5.10 5.05 6.06 7.07 7.07 8.82 9.80
Death rate (%) 0.00 0.00 2.04 2.02 2.02 2.02 2.02 2.94 2.94
Detroit New cases 22 — 0 — 0 — 8 — —
New deaths 3 0 0 0 0 0 0 0 0
Case rate (%) 19.47 19.20 17.52 17.22 15.85 15.47 18.95 18.32 18.10
Death rate (%) 2.65 2.40 2.19 1.99 1.83 1.66 1.58 1.49 1.43
Iron Mountain New cases — 0 0 0 7 4 3 4 —
New deaths 0 0 0 0 — — 0 0 0
Case rate (%) 4.35 4.08 3.57 2.90 12.00 16.05 18.82 21.74 22.34
Death rate (%) 0.00 0.00 0.00 0.00 2.67 3.70 3.53 3.26 3.19
Saginaw New cases 7 3 0 0 0 — 8 8 —
New deaths 0 — 0 0 0 0 — 0 0
Case rate (%) 5.60 6.71 6.45 5.81 5.29 5.88 8.66 10.69 10.82
Death rate (%) 0.00 0.67 0.65 0.58 0.53 0.49 0.87 0.76 0.75
MN Minneapolis New cases 3 — 3 3 3 11 8 4 7
New deaths — 0 — — — — 0 0 0
Case rate (%) 2.05 2.26 3.50 4.35 5.08 8.36 10.36 10.65 12.18
Death rate (%) 0.68 0.56 1.00 1.30 1.56 1.74 1.62 1.48 1.42
St. Cloud New cases 0 0 0 0 — 39 4 5 3
New deaths 0 0 0 0 — — 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.73 14.54 15.85 17.36 18.21
Death rate (%) 0.00 0.00 0.00 0.00 0.37 0.71 0.70 0.69 0.69
MO Columbia New cases — — 0 0 — 10 4 5 0
New deaths 0 0 0 0 0 0 — — 0
Case rate (%) 1.92 2.90 2.60 2.30 4.21 14.00 16.22 19.33 19.17
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.90 1.68 1.67
Poplar Bluff New cases 0 0 0 — 0 0 — 0 0
New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.00 0.00 0.00 4.00 4.00 4.00 11.54 11.11 11.11
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 3.85 3.70 3.70
Page 16 GAO-21-369R VA CLC COVID-19 Data
Saint Louis New cases 21 — — — 11 19 24 22 9
New deaths — 0 0 0 0 — — — —
Case rate (%) 13.82 13.69 12.24 11.26 14.40 19.57 25.82 29.62 30.56
Death rate (%) 0.66 0.60 0.51 0.45 0.40 0.71 0.98 1.17 1.39
MS Biloxi New cases — 0 19 6 — 7 4 6 0
New deaths — 0 0 — 0 0 0 0 0
Case rate (%) 1.65 1.53 13.29 15.70 16.02 19.05 20.62 22.77 22.66
Death rate (%) 0.83 0.76 0.63 1.16 1.10 1.06 1.03 0.99 0.99
Jackson New cases 0 — — — — — 12 3 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 1.39 2.60 3.70 4.65 5.38 17.17 18.87 19.44
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MT Miles City New cases 0 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NC Asheville New cases 0 0 — — 0 — 0 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.98 2.56 2.42 3.01 2.96 3.70 3.70
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Durham New cases 9 — 0 0 — 0 — 4 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 10.59 12.36 11.58 10.58 10.62 9.68 10.61 12.16 12.67
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Fayetteville New cases — 0 — — 0 0 — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 3.23 3.08 4.48 7.25 7.14 7.14 8.57 10.00 10.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Salisbury New cases 10 0 4 — 0 — 5 23 3
New deaths — 0 0 0 0 0 0 0 0
Case rate (%) 6.54 6.54 8.54 8.72 8.20 8.85 10.43 20.93 22.02
Death rate (%) 0.65 0.65 0.61 0.58 0.55 0.52 0.47 0.47 0.46
ND Fargo New cases 0 0 0 0 — 3 3 — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 1.22 4.49 7.29 9.18 9.80
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NE Grand Island New cases — 0 — — 0 — — 3 3
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 3.28 2.94 3.90 4.65 4.30 5.88 7.55 9.82 11.57
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NH Manchester New cases — 0 0 0 0 — — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 4.55 4.35 4.17 4.08 4.00 5.88 7.55 10.91 10.53
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 17 GAO-21-369R VA CLC COVID-19 Data
NJ Lyons New cases 120 — 0 4 — 3 — — 4
New deaths 28 0 0 0 0 0 0 0 0
Case rate (%) 50.63 51.48 51.48 53.16 53.78 54.58 53.88 54.47 55.42
Death rate (%) 11.81 11.81 11.81 11.81 11.76 11.67 11.43 11.38 11.24
NM Albuquerque New cases 0 0 0 0 — — 3 3 —
New deaths 0 0 0 0 0 — — 0 0
Case rate (%) 0.00 0.00 0.00 0.00 1.10 2.17 4.85 7.08 8.47
Death rate (%) 0.00 0.00 0.00 0.00 0.00 1.09 1.94 1.77 1.69
NV Reno New cases — — — 0 — 11 14 8 —
New deaths 0 0 0 0 0 — 3 — 0
Case rate (%) 1.19 2.30 3.23 2.88 3.33 11.72 21.80 25.17 25.32
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.78 3.01 4.08 3.90
NY Albany New cases 0 0 0 0 0 0 — — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 1.43 4.00 5.19
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Batavia New cases 5 0 0 0 0 7 8 24 —
New deaths — 0 0 0 0 0 0 — 0
Case rate (%) 6.41 6.02 5.95 5.68 5.32 12.37 20.20 44.00 44.66
Death rate (%) 1.28 1.20 1.19 1.14 1.06 1.03 1.01 2.00 1.94
Bath New cases — 0 0 0 — 0 6 10 —
New deaths 0 0 0 0 — 0 0 0 0
Case rate (%) 1.09 1.06 1.04 0.93 1.65 1.53 5.56 11.61 11.80
Death rate (%) 0.00 0.00 0.00 0.00 0.83 0.76 0.69 0.65 0.62
Bronx New cases 26 3 0 0 — 3 — — 0
New deaths 4 0 0 0 0 0 0 0 0
Case rate (%) 40.63 40.85 35.80 33.72 34.07 36.56 37.63 36.73 36.00
Death rate (%) 6.25 5.63 4.94 4.65 4.40 4.30 4.30 4.08 4.00
Buffalo New cases — 0 0 0 — 0 0 7 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 8.33 8.33 8.33 8.33 11.11 8.82 7.32 17.24 17.74
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Canandaigua New cases 0 0 0 0 0 0 0 11 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.91 10.53
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Jamaica New cases 103 0 7 — — 0 — 3 —
New deaths 14 0 — 0 0 0 0 — 0
Case rate (%) 56.91 56.28 56.99 56.35 54.63 52.83 52.07 52.25 52.91
Death rate (%) 7.73 7.65 7.77 7.61 7.32 7.08 6.91 7.21 7.17
Montrose New cases 57 0 — 0 — — — 0 0
New deaths 11 0 0 0 0 0 0 0 0
Case rate (%) 61.96 60.64 61.05 60.42 60.20 60.00 61.39 60.19 59.05
Death rate (%) 11.96 11.70 11.58 11.46 11.22 11.00 10.89 10.68 10.48
Page 18 GAO-21-369R VA CLC COVID-19 Data
Northport New cases 29 0 — 0 3 — — 5 —
New deaths 6 0 0 0 0 0 0 0 0
Case rate (%) 20.86 19.46 19.23 18.40 19.19 18.78 18.72 20.83 21.24
Death rate (%) 4.32 4.03 3.85 3.68 3.49 3.31 3.21 3.13 3.11
Syracuse New cases 0 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Wappingers New cases — 0 0 0 0 0 — — 0
Falls New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 5.71 5.56 5.56 5.56 5.13 4.88 6.67 8.51 8.33
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 2.22 2.13 2.08
OH Chillicothe New cases — 0 0 0 — 4 7 3 —
New deaths — 0 0 0 0 0 0 0 0
Case rate (%) 0.53 0.51 0.49 0.48 0.94 2.82 6.07 7.44 7.91
Death rate (%) 0.53 0.51 0.49 0.48 0.47 0.47 0.47 0.47 0.47
Cincinnati New cases 0 0 — 0 — 4 9 — —
New deaths 0 0 0 0 0 — 0 0 0
Case rate (%) 0.00 0.00 0.95 0.86 1.53 4.35 10.79 11.64 12.67
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.72 0.72 0.68 0.67
Cleveland New cases 7 — — 3 — 8 27 18 5
New deaths — 0 — 0 0 — — 0 0
Case rate (%) 2.87 3.08 3.32 3.81 3.95 5.65 10.97 13.86 14.42
Death rate (%) 0.41 0.34 0.60 0.54 0.49 0.71 0.86 0.80 0.78
Dayton New cases — — 3 — 3 5 46 7 5
New deaths 0 0 0 0 — 0 0 — —
Case rate (%) 1.08 1.37 2.41 2.46 3.18 4.42 17.28 17.89 18.48
Death rate (%) 0.00 0.00 0.00 0.00 0.64 0.59 0.57 0.79 1.27
OK Oklahoma New cases — — 0 — 0 3 7 9 6
City New deaths — 0 0 0 0 0 0 — 0
Case rate (%) 1.43 1.68 1.49 1.79 1.58 2.60 5.07 8.10 9.76
Death rate (%) 0.71 0.56 0.50 0.45 0.40 0.37 0.36 0.70 0.67
OR Roseburg New cases 0 0 0 0 0 — 0 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 1.75 1.55 2.24 2.14
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PA Altoona New cases 0 0 0 0 0 6 10 — 3
New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 6.98 16.67 17.35 18.52
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 2.08 2.04 1.85
Butler New cases — 0 — 12 0 — 3 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 1.41 1.35 2.63 18.42 17.95 18.29 19.78 21.51 21.51
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 19 GAO-21-369R VA CLC COVID-19 Data
Coatesville New cases 4 0 0 — — 8 12 — 0
New deaths 0 0 0 0 0 — 0 0 0
Case rate (%) 4.60 4.60 4.60 5.62 6.67 13.33 24.76 25.47 25.23
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.95 0.95 0.94 0.93
Erie New cases 0 0 — 0 0 — — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 1.79 1.72 1.67 3.17 4.62 5.97 5.80
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Lebanon New cases 16 — 0 0 3 5 9 11 3
New deaths 4 0 0 0 0 — 0 — 0
Case rate (%) 15.84 13.08 11.33 9.34 9.13 10.16 12.78 15.57 16.33
Death rate (%) 3.96 3.08 2.67 2.20 1.83 2.03 1.88 2.42 2.38
Philadelphia New cases 24 4 — — — — 5 7 —
New deaths 3 — 0 0 0 0 0 0 —
Case rate (%) 19.83 20.59 19.08 18.29 16.85 16.84 18.72 20.36 20.44
Death rate (%) 2.48 3.68 3.29 3.05 2.72 2.55 2.46 2.26 2.67
Pittsburgh New cases 8 3 — 0 0 10 48 11 3
New deaths 0 0 0 0 0 3 — 0 0
Case rate (%) 2.94 3.77 4.15 3.96 3.72 6.30 18.30 20.30 20.38
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.82 1.29 1.24 1.20
Wilkes-Barre New cases 9 0 0 0 0 3 0 4 —
New deaths 0 0 0 0 0 0 0 3 0
Case rate (%) 10.59 10.34 10.34 10.00 9.68 12.77 12.00 14.68 15.04
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.75 2.65
PR San Juan New cases 0 — — 0 4 — — 8 —
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 0.00 0.58 1.05 0.95 2.46 2.63 3.06 5.36 5.52
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.63 0.61
SC Charleston New cases 0 0 0 0 0 0 0 — 0
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.13 4.88
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.13 4.88
Columbia New cases 0 — 0 0 0 — — — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 2.27 2.20 2.17 2.13 4.21 5.26 7.14 8.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SD Fort Meade New cases 0 0 — 10 3 14 9 3 0
New deaths 0 0 0 — 0 3 0 0 0
Case rate (%) 0.00 0.00 0.96 10.58 12.73 21.71 26.81 26.14 25.32
Death rate (%) 0.00 0.00 0.00 0.96 0.91 3.10 2.90 2.61 2.53
Hot Springs New cases 0 0 0 0 0 3 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 8.11 6.82 6.52 6.38
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 20 GAO-21-369R VA CLC COVID-19 Data
Sioux Falls New cases 0 0 0 — 3 4 5 — —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.92 3.31 6.06 8.90 9.74 10.13
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TN Mountain New cases 0 0 0 — — 0 — — —
Home New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.80 1.50 1.50 2.26 3.01 3.70
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Murfreesboro New cases — 3 12 10 3 5 23 7 5
New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.47 1.83 7.14 11.45 11.93 13.44 22.09 23.62 24.30
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.39 0.37 0.35
TX Amarillo New cases 0 0 — — 18 7 — 4 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 1.74 2.61 18.10 24.14 25.86 29.31 30.17
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Big Spring New cases — 0 0 — 3 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 6.25 6.25 6.06 8.33 16.67 16.67 16.67 16.67 16.22
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Bonham New cases 0 0 0 0 — 3 0 18 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.79 3.15 3.10 17.05 17.05
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Dallas New cases — — 8 5 14 7 12 16 6
New deaths 0 0 0 0 0 0 0 — 0
Case rate (%) 0.74 1.28 3.37 4.26 7.11 8.58 10.48 12.74 13.38
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.39 0.37
Houston New cases 8 45 10 5 5 6 6 21 3
New deaths — — — 0 0 0 — — 0
Case rate (%) 3.45 19.78 21.07 20.67 20.17 20.26 20.33 24.37 24.38
Death rate (%) 0.86 1.49 1.67 1.52 1.38 1.28 1.44 1.61 1.57
Kerrville New cases 0 11 — — 0 0 — — 0
New deaths 0 4 0 0 0 0 0 0 0
Case rate (%) 0.00 10.89 11.21 11.93 11.93 11.61 12.28 14.04 14.04
Death rate (%) 0.00 3.96 3.74 3.67 3.67 3.57 3.51 3.51 3.51
San Antonio New cases 0 3 18 — — — — 4 —
New deaths 0 0 — 0 0 0 — 0 —
Case rate (%) 0.00 2.61 10.66 11.17 11.48 12.09 12.73 14.35 14.91
Death rate (%) 0.00 0.00 1.02 0.97 0.96 0.93 1.36 1.35 1.75
Temple New cases — 0 5 — — — 3 9 4
New deaths 0 0 0 0 0 0 0 0 —
Case rate (%) 1.54 1.26 3.41 3.52 4.26 4.53 5.53 8.19 9.25
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.34
Page 21 GAO-21-369R VA CLC COVID-19 Data
Waco New cases 0 6 0 0 0 — 7 0 —
New deaths 0 — 0 0 0 0 0 0 0
Case rate (%) 0.00 5.50 5.22 5.04 5.04 5.88 11.76 11.76 12.61
Death rate (%) 0.00 0.92 0.87 0.84 0.84 0.84 0.84 0.84 0.84
VA Hampton New cases 0 0 0 0 0 0 0 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.99 2.99
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Richmond New cases — 0 0 0 — 0 — — —
New deaths 0 0 0 0 — 0 0 0 0
Case rate (%) 1.47 1.35 1.27 1.22 2.33 2.25 3.33 5.10 6.00
Death rate (%) 0.00 0.00 0.00 0.00 1.16 1.12 1.11 1.02 1.00
Salem New cases — 0 3 0 0 — — 6 3
New deaths 0 0 — 0 0 0 0 — 0
Case rate (%) 1.11 0.98 3.57 3.57 3.48 5.08 6.72 10.77 12.41
Death rate (%) 0.00 0.00 0.89 0.89 0.87 0.85 0.84 1.54 1.46
WA Seattle New cases — — 0 0 0 — — — 0
New deaths 0 0 0 0 0 0 — — 0
Case rate (%) 2.30 3.26 2.80 2.44 2.16 2.88 3.82 4.17 3.98
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.64 1.19 1.14
Spokane New cases — — 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 3.17 4.35 4.29 4.29 4.29 4.29 4.23 4.23 4.23
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Tacoma New cases 0 0 — 0 0 — — — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 1.79 1.79 1.72 5.17 6.67 9.52 9.38
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Vancouver New cases 0 — 0 — — 9 7 — —
New deaths 0 0 0 0 0 0 — 0 0
Case rate (%) 0.00 0.50 0.44 0.81 1.07 4.15 6.05 6.42 6.53
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.32 0.31 0.30
WI Madison New cases 0 0 0 — — — 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 3.23 6.45 9.68 9.68 9.68 9.68
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Milwaukee New cases 6 3 0 3 — 31 25 10 —
New deaths 0 0 0 0 0 6 — 0 0
Case rate (%) 3.02 4.00 3.73 4.46 4.62 13.43 18.97 20.15 20.20
Death rate (%) 0.00 0.00 0.00 0.00 0.00 1.79 1.90 1.76 1.72
Tomah New cases 5 0 — — 9 12 7 4 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 2.67 2.39 3.03 3.17 6.23 10.21 11.92 12.82 12.66
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 22 GAO-21-369R VA CLC COVID-19 Data
WV Beckley New cases 0 0 0 0 0 0 0 0 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Clarksburg New cases — 0 0 0 0 0 3 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 2.17 1.79 1.61 1.39 1.33 1.12 3.92 4.76 4.67
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Martinsburg New cases 0 3 — — 3 — 4 6 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 1.82 2.99 3.93 5.38 5.58 7.21 9.81 9.68
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WY Cheyenne New cases 0 0 0 — 0 0 0 — 0
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 2.94 2.70 2.56 2.56 5.00 4.88
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Sheridan New cases 0 0 0 0 0 0 6 4 —
New deaths 0 0 0 0 0 0 0 0 0
Case rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 6.12 9.43 10.81
Death rate (%) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Legend: We use “—“ to indicate instances in which there were one or two new cases or new deaths among CLC residents in a given
month. We blinded these instances to protect personal privacy.
Source: GAO analysis of VA data on COVID-19 cases and deaths among CLC residents as of February 2021. | GAO-21-369R
Note: VA officials indicated that the reported number of cases or deaths that occurred in previous months might change over time as
staff continuously update information—such as information on CLC residents who test positive for SARS-CoV-2 (Severe Acute
Respiratory Syndrome, coronavirus 2), the virus that causes COVID-19 (which we refer to as “the virus”)—in VA data systems.
According to VA officials, the data include information on residents who test positive for the virus as well as residents diagnosed with
COVID-19 without a test. We include both instances in the numbers of new cases or new deaths and the case rates or death rates.
VA categorizes cases and deaths by the location in which residents contracted the virus—within a CLC, external to a CLC, or in an
indeterminate location. We combined these categories for our analysis and report cases or deaths collectively.
VA officials told us that they compile data on deaths from any cause that occurred within 30 days of residents being diagnosed with
COVID-19 or testing positive for the virus. Thus, these deaths may be related to COVID-19 but are not necessarily attributable to it.
The reported case rates and death rates are cumulative and represent the percentage of cases or deaths among CLC residents
from March 1, 2020, through the month indicated. We calculated these rates by dividing the cumulative number of cases or deaths
that occurred among residents of an individual CLC from March 1, 2020, through the month indicated by the cumulative number of
residents for the same period. While incidence rates may commonly be standardized by average daily census, VA only provided
cumulative counts of residents at the time of our analysis. As such, the reported rates represent the best available information at the
time.
a
VA compiles the data on new cases and new deaths by month, with the exception of the data for June 2020. According to VA
officials, the data for that date represent the number of new cases or new deaths that occurred between March 1, 2020, and June
30, 2020.
b
The data for February are through February 14, 2021, and do not represent the number or rate of cases or deaths inclusive of the
entire month.
Page 23 GAO-21-369R VA CLC COVID-19 Data
Enclosure II: Comments from the Department of Veterans Affairs
Page 24 GAO-21-369R VA CLC COVID-19 Data
Page 25 GAO-21-369R VA CLC COVID-19 Data
Page 26 GAO-21-369R VA CLC COVID-19 Data
(104697)
Page 27 GAO-21-369R VA CLC COVID-19 Data
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