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Surging Cases and Deaths in Nursing Homes Suggest Another Winter COVID-19 Spike

Booster uptake among residents and workers remains low

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Cases and deaths from COVID-19 are climbing again in U.S. nursing homes, a new AARP analysis of federal data shows, suggesting the start of another surge of the virus heading into winter.

The increase in deaths and cases comes as booster uptake in the facilities remains dismally low, with fewer than half of residents and less than a quarter of staff up to date on their shots as of mid-November.

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More than 1,000 nursing home residents and staff died from COVID-19 during the four weeks ending Nov. 20, according to the analysis, an increase of 200 deaths from the previous four weeks. Meanwhile, cases among residents were up 19 percent, with roughly 1 in 26 testing positive. Staff cases rose 9 percent during the same period, with 1 new case for every 37 residents. 

More recent data from the Centers for Disease Control and Prevention paints a more worrisome picture, with resident and staff cases surging by roughly 65 percent in the two weeks since Nov. 20. 

“It really looks like the winter surge that we’ve been expecting is now underway, just as we have seen the last two years,” said AARP’s Ari Houser, a senior methods adviser and coauthor of the report. 

For the week ending Dec. 4, resident cases climbed to 18,918 (16 for every 1,000 residents), the highest they’ve been since the end of last winter’s omicron wave in early February, according to Houser.

People living and working in nursing homes and other long-term care facilities have been pummeled by the coronavirus pandemic, accounting for roughly a fifth of all U.S. COVID-19 deaths. Of those, more than 175,000 have been residents and staff of nursing homes. Nursing home residents are especially vulnerable because they are older, live in close quarters and often have health conditions that put them at higher risk of dying from COVID-19.

Booster rates continue to lag

Although deaths and cases are down significantly from where they were at the start of the pandemic, Houser said the recent upswing underscores the need for stronger booster uptake.

“The vaccinations and boosters serve two purposes. One is that they are personal protection. If you’re up to date, that’s one of the most important things that you can do to protect yourself,” he said. “But they also protect the community by slowing down transmission. Even residents who are up to date on their vaccinations are vulnerable, so we really need to get the staff bivalent booster rate up to reduce the amount of COVID-19 that’s circulating in nursing homes.”

The Biden administration on Thursday announced a new push to improve the low bivalent booster rates in nursing homes, which includes allowing nursing home staff to administer COVID-19 vaccines to residents. The efforts are part of a broader plan to head off a winter surge as cases rise around the country. 

While most U.S. nursing home residents and staff are vaccinated against COVID-19 (87 and 89 percent, respectively), only 45 percent of residents and just 22 percent of staff were up to date on their vaccines as of mid-November. More than 600,000 residents and 1.5 million workers are without full protection from the virus, according to the analysis. 

Residents and staff are considered “up to date” once they’ve gotten their bivalent booster, which are designed to target some of the recent omicron subvariants. Those who have completed their primary vaccination series or had another booster within the past two months are also considered up to date. 

California led the nation in staff vaccinations for a second consecutive month, but even there, fewer than half of the workers in nursing homes (49 percent) were up to date. Only in five other states — Colorado, Hawaii, Massachusetts, New Jersey and New Mexico — along with Washington, D.C., were even one-third of staff up to date, according to AARP’s latest report. 

Arizona posted the lowest percentage of residents up to date on their shots, at 26 percent, compared to a high of 70 percent in South Dakota.

Houser noted that higher booster rates aren’t likely to stop an impending winter surge, since they are not 100 percent effective against infections. “But the more vaccines and boosters we can get into nursing homes, the more it will help mitigate the surge,” he said. “And it almost certainly will reduce the health impact of the cases that we do see.”

AARP’s analysis, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data from the Nursing Home COVID-19 Public File by the Centers for Medicare & Medicaid Services. Most nursing homes are federally certified and required to submit data to the government each week.

The ongoing analysis captures data only from federally certified nursing homes, not from all long-term care facilities — such as assisted living, independent living, memory care and others — as some other tallies do. An updated analysis will be released next month as new federal data becomes available. Read more about the analysis.

Natalie Missakian is a contributing writer who covers federal and state policy. She previously worked as a reporter for the New Haven Register, and her work has also appeared in the AARP Bulletin and the Hartford Business Journal.