Nursing homes’ cases of COVID-19 down 89%
Numbers are at their lowest level since May
New federal data offers a glimmer of hope in what has been the darkest and deadliest corner of the pandemic.
The number of COVID-19 cases and deaths at America’s nursing homes has dropped significantly since December as millions of vaccine doses have been shot into the arms of residents and staff.
The weekly rate of COVID-19 cases at nursing homes plummeted 89% from early December through the second week of February. By comparison, the nationwide case rate dropped 58% and remains higher than figures reported before late October.
Nursing home cases are at the lowest level since May, when the Centers for Medicare and Medicaid Services began requiring the nation’s more than 15,500 facilities to report cases each week. The 3,505 new cases reported the second week of February are nearly half as many recorded the week before and just one-tenth as many counted in one December week, the highest of the pandemic.
More than 170,000 Americans have died at nursing homes and other longterm care and assisted living facilities, according to state data compiled by the COVID Tracking Project.
The dramatic drop in cases at nursing homes, where nearly 130,000 residents and staff have died since the virus emerged in the USA, raises optimism for brighter days ahead as more Americans get vaccinated, experts said.
A USA TODAY analysis of federal data shows new cases are decreasing within homes at a much faster pace than in communities where the homes are located.
Even as the virus slows nationwide, nursing home cases have dropped at a faster pace than COVID-19 infections overall in about 1,700 of the roughly 2,100 counties with available data.
In 36 counties with more than 150,000 residents, an even more dramatic trend was seen: Nursing home cases plummeted even as infection rates increased in the broader community. In Harris County, Texas, COVID-19 cases were 38% higher in the past three weeks than during three weeks of the December peak. Nursing home cases fell by 31%.
Along with nurses, doctors and other health workers, residents and staff of nursing homes were the first Americans to get vaccinated. As of Thursday, 4.5 million residents and staff received at least one dose and 2.2 million received both doses, according to the Centers for Disease Control and Prevention.
Early data from the federal government provides compelling evidence the vaccine has probably helped keep residents and staff safe, said Dr. June McKoy, a Northwestern University associate professor of medicine, preventive medicine and medical education.
“Only one thing has been introduced that could have caused this dramatic shift in the number of cases per
day,” McKoy said. “It’s the vaccine.”
An analysis of preliminary data collected by the American Health Care Association found new cases dropped at a faster rate when nursing homes vaccinated residents and staff. The analysis compared 797 homes that had vaccinated residents and staff in late December with more than 1,700 homes in the same county that had not vaccinated.
Three weeks after the first vaccine clinic, vaccinated nursing homes had a 48% drop in new cases among residents, compared with a 21% drop among nonvaccinated nursing homes. Case rates among staff, who have been hesitant to accept the vaccine, dropped at homes with vaccine clinics, albeit at a slower rate than among residents.
David Gifford, chief medical officer of the American Health Care Association, said the data shows the vaccine is protecting nursing home residents and staff, and perhaps represents the “light at the end of the tunnel.”
But he cautioned more research is needed to determine how much the drop in cases is attributable to vaccine.
“It’s a little tricky because the cases and deaths are going down everywhere,” Gifford said. “The question is, are they going down because of the vaccine, or are they going down because we’re on the backside of the outbreak. … It’s a combination of both.”
Residents and staff who’ve been infected developed some natural immunity to the virus. When combined with a high percentage of patients getting vaccinated and workers less likely to get the virus in their communities, nursing homes probably benefit from “localized, institutional herd immunity,” said William Schaffner, a Vanderbilt University School of Medicine professor of preventive medicine.
Schaffner said the same phenomenon might be happening at hospitals and medical clinics whose workers have been inoculated in the first phase of vaccine rollout. Though he has not seen data, Schaffner said anecdotal reports suggest fewer health care workers are getting sick from coronavirus.
“One of the consequences is an almost immediate drop in health care worker absences for COVID,” Schaffner said. “Those numbers, they don’t just go down, they go down like a rock in water.”
Vaccine ‘has to be a factor’
States that aggressively rolled out vaccines to nursing homes reported large drops in new cases.
Connecticut, hit hard with outbreaks last spring and again in December, was among the first states to vaccinate residents. The state has completed three rounds of vaccination clinics at nursing homes and assisted living centers since launching its effort during the winter holidays.
Statewide, nursing home resident cases have dropped 91% since early December almost twice as fast as the state at large. In New Haven County, nursing home cases dropped 94% and community cases fell 58% over the past two months.
David Hunter is president and CEO of the Mary Wade Home in New Haven, which includes 94 nursing home and 54 assisted living units. Only one resident has refused to be vaccinated.
Like other homes last spring, Mary Wade was overwhelmed when COVID-19 hit, seeing dozens of cases and 17 deaths. Since the summer, it had only five resident cases in its nursing home units and nine cases among staff, according to federal data. All the cases occurred in December or January. One employee who tested positive worked at two nursing facilities and had received two doses of vaccine, Hunter said.
Hunter said the vaccine “has to be a factor” in reducing COVID-19, along with distancing, separating residents from those who are exposed to the virus and ensuring adequate supplies of personal protective equipment.
Mag Morelli, president of LeadingAge Connecticut, which represents 40 nonprofit nursing homes, said the aggressive vaccine rollout, fewer community cases and nursing homes’ infection control efforts resulted in a “significant drop” in cases.
“We are really pleased with the results,” Morelli said. “We are hopeful that it will keep moving forward.”
Vaccination brings more freedom
Nursing home outbreaks have been problematic throughout the pandemic and usually correlate with how widespread a virus is in a community. The nation’s first confirmed outbreak in the Seattle metro region ripped through Life Care Center of Kirkland, a nursing home linked to more than three dozen deaths.
The Kirkland outbreak underscored the importance of protecting frail nursing home patients. Federal and state governments imposed extensive restrictions on homes such as frequent testing, limiting visitors and maintaining social distancing in common areas such as dining halls.
Though such precautions probably reduced the rate of spread and saved lives in nursing homes, they were not enough to protect residents from dying at record numbers in November and December when community case rates skyrocketed. More than 40,000 nursing home residents died those two months, about a quarter of the toll for the entire pandemic, which started with deaths in January in Kirkland.
For isolated nursing home residents, the arrival of a vaccine and an easing of restrictions cannot come soon enough.
“I don’t think we really understand how seniors are struggling,” McKoy said. “They are starving for human contact.”
McKoy serves as program director of Northwestern’s geriatric medicine fellowship, which trains doctors at a Chicago nursing home and retirement community called the Clare. Nearly all of the community’s 350 residents have been vaccinated and are regularly tested for the coronavirus. The nursing home portion of the complex, called the Terraces at the Clare, reported five resident cases in January, according to federal data.
Kyle Exline, the Clare’s executive director, said some staff members tested positive, possibly from exposures before being vaccinated.
Still, the overwhelming number of residents vaccinated and the home’s rapid testing capability give him confidence. “We feel we’re the safest place in the city,” Exline said.
The Clare is considering softening restrictions to allow seniors who received both vaccine doses more freedom to move around and socialize, McKoy said. Such decisions must comply with CMS, state and city health guidelines.
Though residents have been eager to get vaccinated, the Clare’s nursing home employees were slower to embrace vaccination.
A study in the Journal of the American Medical Association reported that 78% of U.S. nursing home residents took the first vaccine dose, but only 38% of nursing home staff accepted shots.
McKoy said the Clare’s vaccination rate among staff was on par with the figure reported by JAMA. More staffers agreed to get vaccinated after McKoy educated them about the vaccines’ safety.
The weekly federal surveys show that vaccination might play a role in declining cases and deaths among nursing home staff. Over the past two months, confirmed staff cases nationwide have declined 86%, which is 4 percentage points lower than the decline among residents. The decline in deaths has been steeper for residents, down 75%, than for staff members, down 42%.
“I don’t think we really understand how seniors are struggling. They are starving for human contact.” June McKoy, Northwestern University