The COVID-19 vaccination clinics that started rolling out in late December brought swift, substantial drops in infection and death rates in nursing homes, but a new report warns that it’s far too soon to declare victory over the virus in post-acute and long-term care.
In fact, 437 nursing facilities across the country reported their very first cases of COVID-19 in 2021 after keeping the novel coronavirus at bay for the entirety of 2020, according to an analysis from the U.S. PIRG Education Fund.
“I still think nursing homes are a tinderbox,” Dr. Joseph Auslander, a past president of the American Geriatrics Society, said in the report. “People can get sick and die.”
U.S. PIRG, a consumer watchdog group, also found that more than 600 facilities reported three or more new COVID-19 cases during the first week of February, with more than 7,000 reinfections between November 2020 and February 2021 of residents who had previously had the virus and then recovered.
Despite those troubling trends, the group also illustrated the significant positive impact that COVID-19 vaccinations have had on the extremely vulnerable nursing home population, with an 83% drop in weekly resident cases between the start of clinics in December and early February — and an 81% drop among staff.
Deaths, which lag behind infections, had been slashed by 66% by February 7, according to the report.
But the group identified a series of concerns that could hamstring the ongoing progress against COVID-19, including continued shortages of personal protective equipment (PPE) at a small proportion of facilities — a situation that isn’t unique to nursing homes, U.S. PIRG acknowledged, with some hospitals also feeling the pinch — and ongoing confusion about who exactly is responsible for vaccinating new admissions and workers who declined the shots during the original three-clinic federal program.
Those gaps in the vaccination strategy could potentially fuel outbreaks of new COVID-19 variants in nursing homes, even among those who have been vaccinated; U.S. PIRG pointed to a facility in Kentucky where 27 residents and 14 staff were infected with a novel variant despite overall patient and worker vaccination rates of 85% and 48%, respectively.
“This probably won’t be the last new outbreak, particularly with some homes allowing unvaccinated, indoor visitors,” U.S. PIRG speculated.
The group additionally focused on problems with testing, determining that only 40.5% of facilities as of November 22 had performed facility-wide screening of asymptomatic residents once a single case was confirmed, up from 10% in August.
“This is still appallingly low,” U.S. PIRG observed. “If homes didn’t have enough tests or capacity, that’s unacceptable. If they did have enough tests and capacity, and just weren’t testing, that’s unacceptable.”
The watchdog group also took aim at a March 10 decision by the Centers for Medicare & Medicaid Services (CMS) to remove nursing home visitation restrictions in most circumstances. While U.S. PIRG acknowledged that family visits are critical for residents’ social and emotional health — as well as vital backup for overworked frontline staff — the group raised concerns about a lack of a vaccine mandate.
Instead, the organization suggested that facilities allow designated family caregivers access to loved ones as long as they follow proper PPE and testing protocols, a solution that has also been championed by multiple resident advocacy groups.
“As with the states that are carelessly getting rid of mask mandates and allowing large gatherings, it seems nursing homes may act too hastily to ease restrictions and needlessly pose a risk to residents, especially those who haven’t had the opportunity to be fully vaccinated,” U.S. PIRG noted. “While no one disputes the emotional trauma that many nursing home residents have dealt with while unable to see loved ones, it’s irresponsible to eliminate restrictions now when we may be only a few weeks away from a much safer environment in nursing homes.”