Coronavirus vaccines protect residents and staff in skilled nursing facilities against more contagious variants of the virus, according to a
The
Centers for Disease Control and Prevention study reported that the first case identified was in a health-care worker at the facility who had symptoms of Covid-19, the disease caused by the virus, but had not been vaccinated.
The study found that the vaccine was 87 percent protective against the virus in both residents and staff when there were symptoms. It also found that the risk of infection among unvaccinated residents and staff, respectively, was 3 and 4.1 times greater than the risk among the vaccinated.
Overall, the study found the estimated vaccine effectiveness against the coronavirus among residents was 66.2% and among staff was 75.9%. It was 94.4% effective against hospitalizations and deaths for residents.
In the outbreak in early March, "Three residents died, two of whom were unvaccinated," the study report says. Four possible reinfections were identified (one resident and three HCP); of these, one HCP was vaccinated. All four persons experienced symptomatic illness. One resident was infected 300 days earlier and had nine consecutive negative RT-PCR tests before reinfection, including two within 30 days of the outbreak. This resident was hospitalized and died.
Twenty-six residents and 20 staff in the facility tested positive for the coronavirus, including 18 residents and four staff who were fully vaccinated more than 14 days before the outbreak began, according to the report.
"Attack rates were three to four times as high among unvaccinated residents and [health care personnel] as among those who were vaccinated; vaccinated persons were significantly less likely to experience symptoms or require hospitalization," said the report.
In March, when the outbreak was first reported, the Kentucky Department for Public Health only identified the facility as being in Eastern Kentucky, but by all indications it occurred at the Life Care Center of Morehead.
Asked about the study and the outbreak, Bill Hurst, executive director of the center, said, "At this time, I would just want to refer you to the Kentucky Department for Public Health." Again, DPH would not identify the nursing home.
"We have not named the facility," DPH spokeswoman Susan Dunlap said in an e-mail. "As a general operating principle throughout this pandemic, we have tried to respect the privacy of individual persons and facilities."
The CDC study says all of the staff and residents in the nursing home had been offered the two-dose Pfizer-BioNTech vaccine at three different vaccine clinics and that 90% of the residents and 53% of the staff had received both doses of the vaccine. These clinics were offered in every long-term care facility across the state as part of a federal program.
Genomic sequencing determined that the virus that caused the outbreak was the R.1 variant, which is not currently identified as a "variant of concern." The study found that despite "multiple spike protein mutations" in the variant, vaccinated residents and staff were 87% less likely to have symptomatic Covid-19 compared to those who were unvaccinated.
The researchers recognized that coronavirus vaccines are not 100% effective against the virus and that some breakthrough infections are expected. On April 13, the CDC reported about 5,800 such infections in the U.S.; at the time nearly 77 million people who have been fully vaccinated
The report also points out that the risk for poor outcomes among unvaccinated residents is highlighted by the hospitalization of four of the six unvaccinated, infected residents, and two subsequent deaths, including one previously infected resident.
"This underscores the importance of the Advisory Committee on Immunization Practices’ recommendation that all persons, including those who have recovered from Covid-19, be vaccinated," says the report.
In conclusion, the researchers say vaccines are "imperative" to protect skilled nursing facility residents and staff against the coronavirus. Further, they write, “A continued emphasis on strategies for prevention of disease transmission, even among vaccinated populations, is also critical.”
The researchers note several limitations of the study, including that it did not control for underlying health conditions, which may have influenced whether a person chose to be vaccinated, how they died or how they made decisions about hospitalizations. They also note that it is possible that some asymptomatic cases were not identified because of the type of test that were used.
LTC staff vaccines are "imperative" but not required
At the time of publication, DPH had not responded to a question about why DPH didn't require coronavirus vaccines among long-term care staff, since the report says they are "imperative."
According to data provided by the state, an Office of the Inspector General survey conducted in March, with a 100% response rate, found that 73% of the state's long-term care facility residents and 41% of their staff were fully vaccinated; 6% of the residents and 3% of the staff had received one dose of a vaccine.
Dunlap, who is the executive director of public affairs for the Cabinet for Health and Family Services, said the cabinet is working with the Long-Term Care Advisory Task Force to refine targeted messages to the facilities' staff to promote the benefits of the vaccinations.
Inspector General Adam Mather has said that now that the federal vaccination program is over, the state will provide a "maintenance program" to ensure new residents, new staff and reluctant residents and staff would be able to get a shot.
But even with such low vaccine rates among long-term care staff, deaths in the state's long-term facilities have plummeted. Prior to the vaccine, about 68% of the state's Covid-19 deaths were in long-term care facilities, but now that number has dropped to about 36%.
“Our members have seen great strides since the vaccines entered their buildings," Betsy Johnson, president of the Kentucky Association of Health Care Facilities, said in an e-mail. "The number of deaths and illnesses in these facilities has drastically decreased and residents can see their loved ones for the first time in months."
She added that her organization and the Kentucky Center for Assisted Living strongly urge those in long-term care to get vaccinated.
"Due to workforce challenges in this difficult profession, members are choosing not to mandate but instead incentivize, educate, and strongly encourage each employee to be vaccinated," Johnson said. "Long-term care facilities want to be a resource to their employees for such an important and personal decision.”
Louisville Business First reported in January that while some facilities are mandating vaccines, like Louisville-based
Atria Senior Living, others are hesitant to do so largely over fears of driving their employees away, which could have dire consequences in an industry that struggles with a major shortage of workers.
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