As the reporting on COVID-19 fatalities improve, we should expect some shocks, but this one will reverberate more than most. New York has added over 1,700 deaths from nursing homes to the pandemic’s death toll, a number that will once again call into question a series of decisions made by Gov. Andrew Cuomo. Patients and nurses that tested positive got sent back to long-term care facilities, in part to keep from overwhelming other parts of the health-care infrastructure, but those decisions will get a lot more scrutiny now:

New York State is reporting more than 1,700 previously undisclosed deaths at nursing homes and adult care facilities as the state faces scrutiny over how it’s protected vulnerable residents during the coronavirus pandemic.

At least 4,813 people have died from COVID-19 in the state’s nursing homes since March 1, according to a tally released by Gov. Andrew M. Cuomo’s administration late Monday that, for the first time, includes people believed to have been killed by the coronavirus before their diagnoses could be confirmed by a lab test.

Exactly how many nursing home residents have died remains uncertain despite the state’s latest disclosure, as the list doesn’t nursing home residents who were transferred to hospitals before dying.

That added close to 10% alone to the state’s COVID-19 death tally, which now stands at 19,415 as of 11 am ET. That’s one hell of a jump, even by this pandemic’s standards. To put this admission in context, it outstrips the country’s overall total yesterday of 1,176 deaths, and it amounts to half of the global single-day total of 3,555.

The question of how to deal with the particularly vulnerable nursing-home population came up early in the COVID-19 response, Newsday notes, when Cuomo pledged on March 2 to make a “special effort” to protect them. Instead, as the New York Times reported ten days ago, Cuomo ordered patients who tested positive to be returned to nursing homes rather than be kept at a hospital, which one resident called “playing Russian roulette with my life”:

A state guideline says nursing homes cannot refuse to take patients from hospitals solely because they have the coronavirus.

“I don’t like them playing Russian roulette with my life,” said Mr. Nibur, who is on oxygen. “It’s putting us at risk. I am 80 years old with underlying problems. Everybody here has an underlying problem.” …

At the epicenter of the outbreak, New York issued a strict new rule last month: Nursing homes must readmit residents sent to hospitals with the coronavirus and accept new patients as long as they are deemed “medically stable.”

To be fair, California and New Jersey put similar policies in place, and that might have been prompted by fears — later unrealized, but certainly reasonable at that time — of running out of bedspace for acute cases. Cuomo and the state later defended the policy as being in consonance with guidance from Medicare/Medicaid, but Newsday notes that CMS specifically restricted COVID-19 readmissions to nursing homes to those facilities that could ensure against retransmission. At the same time New York was sending those patients back, however, it went even further by allowing COVID-positive nurses back to work in nursing homes, as the New York Post reported last week:

The state Health Department allowed nurses and other staff who tested positive for the coronavirus to continue treating COVID-19 patients at an upstate nursing home, The Post has learned.

State officials signed off on the move during an April 10 conference call that excluded local officials from Steuben County, who protested the move, according to a document provided by the county government’s top administrator, Jack Wheeler.

At least 15 people have died at the Hornell Gardens nursing home in the tiny town of Hornell since the outbreak, according to county tallies. State records show just seven deaths across the county and include no data about this home.

Clearly Cuomo will have to answer for those decisions in light of this new data, but perhaps he might need to answer why this data is new at all. It’s a product of better testing capability, surely, but why weren’t symptomatic patients diagnosed? Did a burst of these occur in facilities with known-positive readmissions and/or staff? If so, or even if not, how did the circumstances of these deaths get missed at the time, especially when Cuomo had pledged to pay special attention to the situation in nursing-home care? Why did all of these get reclassified today — and how many more might be reclassified tomorrow and in succeeding days?

If Cuomo wants to maintain his political standing, enhanced by his early leadership in the pandemic, he’d better provide answers to these questions tout suite. Otherwise, the impression that Cuomo might have had the worst response to the crisis will start firming up — quickly.