WASHINGTON (AP) — Deaths among Medicare patients in nursing homes soared by 32% last year, with two devastating spikes eight months apart, a government watchdog reported Tuesday in the most comprehensive look yet at the ravages of COVID-19 among its most vulnerable victims.

The report from the inspector general of the Department of Health and Human Services found that about 4 in 10 Medicare recipients in nursing homes had or likely had COVID-19 in 2020, and that deaths overall jumped by 169,291 from the previous year, before the coronavirus appeared.

“We knew this was going to be bad, but I don’t think even those of us who work in this area thought it was going to be this bad,” said Harvard health policy professor David Grabowski, a nationally recognized expert on long-term care, who reviewed the report for The Associated Press.

“This was not individuals who were going to die anyway,” Grabowski added. “We are talking about a really big number of excess deaths.”

Investigators used a generally accepted method of estimating “excess” deaths in a group of people after a calamitous event. It did not involve examining individual death certificates of Medicare patients but comparing overall deaths among those in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus surge last spring. It does not attribute a cause of death but is seen as a barometer of impact.

Death rates were higher in every month last year when compared with 2019. The report documented two spikes with particular implications for government policy and for protecting the most vulnerable in future outbreaks of life-threatening illnesses. In April of last year, a total of 81,484 Medicare patients in nursing homes died. Then eight months later, after lockdowns and frantic efforts to expand testing — but before vaccines became widely available — nursing home patients accounted for a staggering 74,299 deaths in December.