CDC: Outbreak of more contagious virus strain in nursing home began with unvaccinated employee; vaccines can prevent such

Life Care Center of Morehead (Company photo)

 In state health department video, nursing-home staff say why they got a shot.

This story has been updated with comments from state officials.

By Melissa Patrick
Kentucky Health News

Coronavirus vaccines protect residents and staff in skilled nursing facilities against more contagious variants of the virus, according to a Centers for Disease Control and Prevention study of an outbreak of a more contagious variant in a Kentucky nursing home.
The 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. Only 53 percent of the health-care workers at the facility had been vaccinated, the study said, while 90% of the residents had.
The outbreak and the study provided a test of vaccines against the more contagious variant, which had not been identified until the outbreak.

The study found that the vaccine was 87% protective against Covid-19 symptoms in both residents and staff. 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.

For prevention of infection by the virus, the vaccine was 66% effective among residents and 76% effective among staff. It was 94.4% effective against hospitalizations and deaths for residents. “Vaccinated persons were significantly less likely to experience symptoms or require hospitalization,” the study says.

In the outbreak in early March, “Three residents died, two of whom were unvaccinated,” the study report says. Four possible reinfections were identified,” in a resident and three workers, one of whom was vaccinated. All four had Covid-19 symptoms. One resident, who had been infected last May and had nine consecutive negative tests before reinfection, including two within 30 days of the outbreak, “was hospitalized and died,” the study says.
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, including day-to-day, facility-specific data published by the department, it occurred at the Life Care Center of Morehead.
Bill Hurst, the facility’s executive director, referred questions to the department, which again refused to identify the nursing home. Department 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.”
Health Commissioner Steven Stack said as he discussed the study at Gov. Andy Beshear’s briefing Thursday afternoon, “The facility didn’t do anything wrong. They participated and did all the things they were supposed to do.”
Beshear, asked why he hadn’t required nursing-home workers to get vaccinated, said “There are some legal concerns with making it mandatory,” and said any such mandate might cause a further decline in vaccinations. It is unclear whether the vaccines can be required because they are authorized for emergency use.

Beshear said nursing-home operators “need to make an extra push to get their people vaccinated,” showing them the harm that can result from not doing so, but wasn’t sure whether state officials have suggested that that the operators make it mandatory.

Louisville Business First reported in January that some facilities, such as Louisville-based Atria Senior Living, are mandating vaccines, but others are hesitant to do so, largely for fear of driving away employees in an industry that struggles with chronic shortages of workers.
The study says all of the staff and residents in the nursing home had been offered the two-dose Pfizer-BioNTech vaccine in three separate clinics, offered in every long-term care facility in the state as part of a federal program.

Genomic sequencing determined that the virus that caused the outbreak was an R.1 variant, which is not currently identified as a “variant of concern.”  The study says that despite “multiple spike protein mutations” in the variant, which makes it more contagious, vaccinated residents and staff were 87% less likely to have symptomatic Covid-19 compared to those who were unvaccinated.

The researchers note 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 had been fully vaccinated. That is 0.007%, less than one in 1,000.

They said the hospitalization of four unvaccinated residents, and the deaths of two, underscores the importance of the CDC’s advice “that all persons, including those who have recovered from Covid-19, be vaccinated.” They add later, “A continued emphasis on strategies for prevention of disease transmission, even among vaccinated populations, is also critical.”

Staff vaccines are ‘imperative’ but not required 

In conclusion, they say vaccines are “imperative” to protect residents and staff from skilled nursing facilities from the virus.

The Department for Public Health was asked why the state hasn’t required coronavirus vaccines among long-term care staff to be vaccinated. It has not responded to the question.

According to a state Office of the Inspector General survey of all nursing homes in March, 73% of residents and 41% of staff were fully vaccinated, and 6% of the residents and 3% of the staff had received one dose of a vaccine.

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, said her organization and the Kentucky Center for Assisted Living strongly urge those in long-term care to get vaccinated, but “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.”
Dunlap, who is executive director of public affairs for the Cabinet for Health and Family Services, said the cabinet is working with its Long-Term Care Advisory Task Force to refine targeted messages to facilities’ staff to promote the benefits of vaccination.
Now that the federal vaccination program is over, cabinet Inspector General Adam Mather has said, the state has a “maintenance program” to ensure that new residents, new staff, and reluctant residents and staff are able to get a shot.
Even with so many long-term care staff unvaccinated, deaths in such facilities have plummeted. Prior to vaccinations, which began with the facilities and other health-care workers, about 68% of the state’s Covid-19 deaths were in long-term care, but that number has dropped to about 36%.
“Our members have seen great strides since the vaccines entered their buildings,” Johnson said. “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.”
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