Health officials in some states have begun sounding the alarm about coronavirus outbreaks among long-term care facility and nursing home staff and residents as the highly contagious delta variant fuels cases in communities across the country.
Covid-19 deaths in long-term care facilities have plunged with the availability of vaccines, and government data shows 81 percent of nursing home residents are now fully vaccinated. But the rise of the delta variant and concerns about the vaccination rate of the people working in those facilities, which in some states in the South is lower than 50 percent, has experts and advocates worried about outbreaks.
While experts said there is no data yet to suggest Covid cases are spiking widely in long-term care facilities and nursing homes nationwide, in some places, including Mississippi and Indiana, officials have said unvaccinated workers are spreading the virus.
The fears come as the Centers for Disease Control and Prevention warns delta is “highly contagious, likely to be more severe” and that although rare, “breakthrough infections may be as transmissible as unvaccinated cases.”
In Mississippi, the state epidemiologist said Wednesday there were more than 100 outbreaks in long-term care facilities in the state, 72 of which were in nursing homes.
“The primary driver of those nursing home outbreaks are infections in unvaccinated staff and employees,” Dr. Paul Byers said during a video news conference. “Regrettably, in some cases, these infections are spilling over into the residents and into fully vaccinated residents at times.” Some of those cases among residents did result in severe illness, he said.
“It's going to be imperative that we continue as health care workers and health care staff in long-term care settings to increase our vaccination rates among those employees, which are still below 50 percent across the state, and lower in some facilities,” he said.
In Indiana, seven residents died recently at an unnamed facility where less than half of the staff was vaccinated, local health officials said earlier this month. Cases have also been rising in Southern states, including in Louisiana and Texas.
The primary concern among experts and advocates is over the low number of vaccinated staff in some states, especially in the South, reflecting the challenge of uneven vaccination rates across the country.
Nationally, some 58 percent of staff and 81 percent of residents in nursing homes have been vaccinated, according to data from the U.S. Centers for Medicare and Medicaid Services. But those numbers can vary greatly depending on the state, with Louisiana, Florida, Missouri, Oklahoma, Mississippi, Georgia, Tennessee and Kentucky ranking among the lowest, with less than 50 percent of staff having completed their vaccinations.
Ari Houser, a senior methods adviser with the AARP Public Policy Institute, said the group’s worry is the interaction between low vaccination rates in the community enabling the virus to surge and low vaccination rates among staff increasing the likelihood of bringing Covid into a nursing home and “making those residents vulnerable if the virus does get in.”
Houser said while things have gotten much better since the height of the pandemic, “Covid never went away, and because it's still circulating among nursing homes in every state and among communities in every state, there remains the potential for it to re-establish and have another spike.”
AARP has been tracking vaccination rates among staff as well as monitoring ongoing cases in residents, he said. There have been small increases in cases and some signs of rising cases among workers, and Houser said the worry is this could eventually lead to a larger increase.
“We're hoping that we don't see a big increase, but we're concerned that we will, especially in the states with low vaccination rates,” he said.
Rupali Limaye, the director of behavioral and implementation science at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, said staff at long-term care facilities and nursing homes often are “essentially in very close contact with and therefore at higher levels of risk exposure to individuals that are also susceptible. So this continues to be a key challenge.”
On Monday, nearly 60 major health care organizations signed a joint statement in support of vaccine mandates for workers in health and long-term care. Among them was LeadingAge, which represents more than 5,000 nonprofit aging services providers, including nursing homes.
One challenge for providers, especially in communities where vaccination rates are low and there may be distrust of vaccines, is the question of whether a mandate will exacerbate workforce shortages.
Katie Smith Sloan, the president and CEO of LeadingAge, said in a statement to NBC News that as new Covid variants emerge and proliferate, “even fully vaccinated older adults in long-term care seem to be at risk.”
“Vaccines are a game changer — the most effective tool we’ve got to protect from the virus. That’s why we support requiring vaccines for current and new staff in long-term care and other healthcare settings,” she said. “We don’t want a repeat of what we’ve been through, for anyone — not for older adults, or the people who care for them.”
“Care providers have been working around the clock to steadily increase the number of residents and staff who are vaccinated, and Covid deaths have plummeted, but it’s time to do more. We can start saving more lives today by ensuring staff are fully vaccinated,” she said.
LeadingAge said according to the latest data available Thursday, 66.63 percent of staff were fully vaccinated and 89.38 percent of residents were fully vaccinated.
"As we see in the general population where vaccination rates vary by state and by community, we also see that vaccine rates among long-term care workers also varies and vaccine hesitancy is very real," said Lisa Sanders, director of media relations for LeadingAge. "It's a continuing process. It's constant."
The thought of outbreaks is particularly alarming to people like Bill Borrelle, whose 95-year-old mother is legally blind and hard of hearing and lives in an assisted living facility in New Jersey. Borrelle is also the founder of FACE NJ, or Family Advocate Care Experience, an advocacy group for family members with loved ones in long-term care in the state.
In running a Facebook group with more than 1,500 members, Borelle has seen “great concern” from family members, “one after the next” writing in to describe lockdowns at facilities.
Their fear is there will be “rising cases in facilities that will trigger lockdowns to happen again, families will be kept out and isolation can kill,” he said.
When the pandemic began, long-term care facilities across the country shut their doors to visitorsand largely kept residents to their rooms to protect them. But the confinement meant to protect the most vulnerable people in some cases also threatened their lives as patients deteriorated in isolation.
The trauma of that reality came back for Borrelle when he received an email this week that he said made his “heart skip a beat”: an unvaccinated member of the staff where his mother lives had tested positive for Covid.
Fortunately, the individual typically has no contact with residents, and the facility said no change to its visitation policy has been made so far.
“But just imagine if that sentence ended differently,” Borrelle said. “In a moment, it all comes back. I don't want her to die in isolation, and I've known too many stories of fantastic people that are a part of this group.”