En español | An unvaccinated health care worker is believed to be at the epicenter of a March COVID-19 outbreak in a Kentucky nursing home where nearly 50 people were infected, including 18 fully vaccinated residents. Three residents — including two who were unvaccinated — died, according to a review of the incident published Wednesday by the U.S. Centers for Disease Control and Prevention (CDC).
The report illustrates the dangers posed by unvaccinated staff in nursing homes, experts say. Almost all U.S. facilities have completed vaccination clinics through a federal partnership with CVS and Walgreens. But participation among staff has been much lower than among residents. In the unnamed Kentucky facility, 75 of the 83 residents had received two doses of Pfizer's vaccine. Just 61 of the 116 staffers were similarly inoculated at the time.
"The higher the amount of unvaccinated staff, the greater likelihood there will continue to be outbreaks,” says Mike Wassterman, a geriatrician and past president of the California Association of Long Term Care Medicine.
Many nursing home employees work long hours for low pay, with little if any sick leave, contributing to vaccine hesitancy. Adelina Ramos, a certified nursing assistant at a Rhode Island nursing home who recently testified before the Senate Finance Committee, told AARP last month that many of her coworkers “didn't want to be the guinea pigs, so they were waiting to see who goes first and see how their reactions were."
But the CDC report's authors also suggest the outbreak is an example of vaccines doing what they're supposed to: limiting serious medical complications from COVID-19. They note that “vaccinated persons were significantly less likely to experience symptoms or require hospitalization” if infected. Eighteen of the unnamed facility's 75 fully vaccinated residents were infected during the outbreak, but only one was hospitalized and later died. Meanwhile, six of the facility's eight unvaccinated residents were infected. Four were hospitalized, and two died.
"There's a dramatic difference among vaccinated and unvaccinated residents, and that's not surprising,” Wasserman says of the report. “We know the vaccines work, and we know they make a huge difference."
The report also notes the outbreak was caused by a virus variant that the vaccines were not specifically designed to guard against. Still, vaccinated residents and staff were 87 percent less likely to have COVID-19 symptoms if they became infected than their unvaccinated counterparts. Wasserman says he thinks the outbreak would have been much worse had it taken place several months ago, before residents and staff were vaccinated. “It's not going to be perfect, but we've made tremendous progress,” he says.
Some state governments are trying to bolster nursing home staff vaccination rates, with New York's Department of Health this week asking nursing homes to give workers another opportunity to get vaccinated — and requiring them to fill out paperwork if they decline. But Wasserman says he doesn't expect government officials or many individual facilities to require their workers to get a vaccine anytime soon, in part because so many facilities continue to report staffing shortages.
An average of more than 1 in 5 nursing homes across the country reported a staffing shortage during the four weeks ending March 21, according to the latest AARP Nursing Home Dashboard analysis. “Anything you do that limits staff is a risk. So yes, requiring the vaccine could exacerbate that,” Wasserman says.
The report was published the same day the CDC issued a separate but similar analysis of COVID-19 outbreaks in Chicago nursing homes. That study looked at outbreaks that occurred between the day of a facility's first vaccine clinic and March 31. It documented 627 infections in 75 facilities.
Roughly 94 percent of the residents and staff who tested positive were either unvaccinated or only partially vaccinated, with infections confirmed in only 22 fully inoculated people. Of those, only eight were symptomatic, two were hospitalized and one died. “Most fully vaccinated persons were not infected, did not have COVID-19-like symptoms and did not have severe illness,” according to the study.
Andrew Soergel covers nursing homes and federal and state policy for AARP. He was previously a senior economics writer at U.S. News & World Report and was awarded an Economics of Aging and Work fellowship through the Associated Press-NORC Center for Public Affairs Research at the University of Chicago.