Coronavirus: How bad is the crisis in US care homes?

Elder care homes across the US have been hard-hit by the virus - though the true extent of the severity remains unclear, months in. One thing is certain, however - Covid-19 has yet again highlighted long-standing flaws in America's health system.

When Michael Colwell received the call that his mother-in-law Helen Osucha had passed away at her nursing home in Geneva, Illinois, he says they told his family the 97-year-old died peacefully in her sleep.

A day later, the funeral home that had received Helen's body told them she had Covid-19.

As they grieved, holding Helen's funeral with family calling in on computer screens, the question remained. Why weren't they told?

"It just didn't feel that this is the way the world should work."

Mr Colwell says the home informed them that there were "a case or two" of Covid-19, but they had no idea of the full extent.

"They telephoned us on the day of her death, late in the evening on the 26 of April and said she had passed away peacefully in her sleep. The fact that that's how she went gave my wife some comfort. But then to learn the next day that she died of Covid-19 - it was a very big shock."

Helen was a part of the Greatest Generation, Mr Colwell begins when asked to describe his mother-in-law. She lost a brother in World War Two. Her husband was a B-17 navigator, and they married when the war ended.

For years, she worked at a longstanding Chicago restaurant - the Como Inn - as a bookkeeper and waitress, making many friends among the close-knit Polish community. She often held family gatherings and was an active member of her church - a "kind-hearted, generous woman".

"Maybe we could've said a prayer or done something," Mr Colwell says. "Initially when they restricted visits from family because of the pandemic, we were told that if the [resident] was in fact dying, they would have hospice come in and we would be allowed to go in and see her.

"And of course, that never happened because we didn't know."

Mr Colwell's lawsuit against Bria is one of six now levied against the facility over its coronavirus response.

Bria has placed the blame on a lack of testing, calling the virus a "silent enemy impossible to detect and difficult to defeat", and says they followed public health guidelines as the situation evolved.

A spokeswoman for the home told the BBC: "We mourn the loss of our patients, for many of whom we cared for many years, and we share the anguish of their loved ones."

What does the data show?

So far, facilities across the US have reported over 126,400 confirmed Covid-19 cases leading to the death of 35,517 residents and hundreds of staff to the Centers for Medicare and Medicaid Services (CMS). Bria of Geneva has reported 16 Covid-19 deaths to CMS.

Johns Hopkins University puts the US death toll at over 133,000 as of 10 July - which means that by current federal figures, care homes account for a quarter of all US coronavirus deaths.

But other counts, drawing from state data, say the toll could be far higher: over 50,000, according to reports by the Wall Street Journal and the New York Times.

An analysis by the non-partisan Foundation for Research on Equal Opportunity found 45% of US Covid-19 deaths came from nursing homes - a group that makes up just 0.6% of the US population.

But that still isn't the full picture.

Many submissions to CMS have not passed data quality checks; homes are also not required to provide data from before May. This means that while some states seem to have shown promising numbers so far, there are caveats.