Unvaccinated staff scrutinize increase in COVID cases in nursing homes
Some policy experts are urging the government to require nursing home staff to get vaccinated, but operators fear this may prompt some to simply quit their jobs.
WASHINGTON – Trolling vaccination rates among nursing home staff linked to a nationwide rise in COVID-19 infections and deaths in senior facilities in July, and at the center of a federal investigation in a hard-hit Colorado location where disease detectives found many workers were not vaccinated.
The investigation by the Centers for Disease Control and Prevention of facilities in the Grand Junction, Colo. Area raises concerns among public health physicians that successes in protecting vulnerable seniors with vaccines could be at risk then as the more aggressive delta variant spreads across the country.
Nationally, about 59% of nursing home staff have received their vaccines, roughly the same percentage as the overall percentage of fully vaccinated adults – but significantly lower than the roughly 80% of residents who are vaccinated, according to Medicare. And some states have much lower vaccination rates, around 40%.
Some policy experts are urging the government to close the gap by requiring nursing home staff to be vaccinated, a warrant the Biden administration has been reluctant to issue. Nursing home operators fear that such a move could backfire, prompting many vaccine-hesitant staff to simply quit their jobs.
Certainly, the vast majority of fully vaccinated people who are infected with the delta variant only experience mild symptoms.
But “older people may not respond fully to the vaccine and there is a huge risk that someone will come in with the virus,” said Dr Joshua Sharfstein, associate dean of public health practices at the Johns Hopkins Bloomberg School of Public Health.
“Vaccination of workers in nursing homes is a national emergency because the delta variant is a threat even to those who are already vaccinated,” he said.
The CDC conducted its investigation into delta variant epidemics at senior care facilities in Mesa County, Colorado, in May and June. The region is a hotspot for the coronavirus. The agency said it was helping states and counties across the country as part of the White House’s COVID-19 “rescue teams”.
Nationally, data collected by the CDC shows that deaths and confirmed infections among nursing home staff have declined significantly since vaccinations began in January. But the number of reported staff deaths in July has started to rise again, fueling new concerns.
At a memory-care facility in the Grand Junction area, 16 fully vaccinated residents were infected and four died, according to a CDC slide provided to The Associated Press. Residents who died were described as being in hospice care, with a median age of 93, indicating they were particularly frail.
The CDC has not released the results of its investigation, but said it plans to publish the results in an upcoming weekly morbidity and mortality report. The slide was shared with the AP by someone involved in internal deliberations, who requested anonymity as they did not have permission to release the data.
Of the 16 fully vaccinated residents infected at the memory care facility, the CDC found that 13 had developed symptoms, described as mild in most cases.
The CDC investigated several nursing homes in Mesa County that were experiencing new outbreaks. At one location – described as “Facility A” – 42% of staff were still not fully immunized, compared with only about 8% of residents who had failed to get immunized.
The CDC has found a 30% COVID-19 infection rate among vaccinated residents and facility staff, with residents accounting for the vast majority of cases.
Throughout the pandemic, people in long-term care facilities have borne a disproportionate burden of suffering and death, not to mention increased isolation from lockdowns. Nursing home residents are estimated to make up about 1% of the U.S. population, but they account for about 22% of deaths from COVID-19 – more than 133,400 people whose lives have been lost.
Experts generally agree that staff are one of the main triggers of outbreaks in nursing homes, as workers may unintentionally introduce the virus to the surrounding community before they develop symptoms.
With the arrival of vaccines and an aggressive effort to get residents vaccinated, cases and deaths have plummeted and care homes have come out of lockdown. But COVID-19 has not been wiped out. In the week ending July 4, 410 residents were ill across the country and 146 died.
Colorado is not alone in seeing outbreaks in nursing homes, as much of the staff is unvaccinated.
In Indiana, seven residents died from COVID-19 at a facility where less than half of the staff – 44% – were fully immunized, said Dr. Emily Backer, Howard County health official. Eleven additional residents tested positive during the outbreak which officials say began in mid-June.
One of those who died was fully vaccinated and five fully vaccinated residents were among those who tested positive, Backer added. She would not name the establishment.
Backer acknowledged that the vaccination rate of 44% of the staff at the facility was “less than we would like.”
“But at this point,” she added, “they can’t force them.”
Backer said she was troubled by the continued resistance to the vaccination, fueled by exaggerated claims about side effects. Some experts fear that hard-won progress in tackling nursing home outbreaks may be lost, at least in some communities.
Laura Gelezunas has first hand experience of a revolutionary case in a retirement home.
After numerous calls and emails to her mother’s retirement home in Missouri and the company’s headquarters in Tennessee, Gelezunas finally got confirmation that her congestion, headache and sore throat was mother were showing symptoms of COVID-19.
However, Gelezunas said the facility was not transparent about how her vaccinated mother, Joann, became ill. While the house has reported outside visitors, Gelezunas said his mother’s only visitors are his brother and wife, both of whom are vaccinated. Gelezunas believes it was an unvaccinated staff member, but the outbreak has yet to provide answers.
Gelezunas asked his mother to interact only with vaccinated workers, but managers said they could not make promises due to privacy concerns and their inability to force vaccinations on workers.
“My mother is bedridden. I have people who care for her intimately and you tell me you can’t tell me that at $ 7,500 a month my mom can’t have someone who is vaccinated to take care of her. ‘she,’ said Gelezunas, who lives in Mexico.
Joann told her daughter that between 12 and 15 residents were infected with the virus recently, which she found out by one of her assistants.
When it comes to requiring vaccinations, one of the hurdles is that COVID-19 vaccines are not yet fully approved by the Food and Drug Administration and are administered under emergency clearance.
“What we need to do is move beyond the baseline of emergency use, to make (immunization) a standard of care,” said Terry Fulmer, president of the John A. Hartford Foundation, an organization at nonprofit working to improve care for the elderly.
Highlighting the potential vulnerability, government figures show a wide disparity between states in nursing home immunizations. Vermont has fully immunized 95% of its nursing home residents, but in Nevada the figure is 61%. Hawaii is the leader in personnel immunizations, with 84% fully immunized. But in Louisiana, it’s half, 42%.
Harvard healthcare policy professor David Grabowski said he believes trust is the central issue for many nursing home staff who remain unvaccinated. Low-paid workers may not have much confidence in the immunization messages of the management of their establishments.
“I think that in part reflects what we see in the general population, but among healthcare workers it’s really baffling,” Grabowski said.
Backer, an Indiana County health official, accuses the swirling misinformation.
“There is a lot of really bad information that is completely wrong,” she said. “It’s really sad because I think we have the power to end this with vaccination. No one else needs to die from it.”
Dearen reported from New York. Associated Press writer Kathleen Foody in Chicago and Patty Nieberg in Denver contributed.