On September 9 JAMA published a cross-sectional study that compared state and federal COVID-19 nursing home data reported early in the pandemic. The federal government did not require reporting of COVID-19 cases and deaths in nursing homes until May 24, 2020. An estimated 44.7% of COVID-19 cases and 40% of COVID-19 deaths that occurred prior to May 24, 2020 were not reported in the first CDC National Healthcare Safety Network (NHSN) submission. One factor may have been pressure on nursing homes to report fewer cases and deaths.