Covid-19 cases and deaths are rising once again in U.S. nursing homes as vaccination rates have hit new lows, paving the way for a potential surge in infections during the upcoming winter months.

This is according to the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, which also found that Covid-19 deaths among nursing home residents over the four weeks ending in November 19 were more than four times higher than those recorded over a similar period ending in June 25.

“In each of the previous three years, the most severe Covid-19 impacts happened in late fall and early winter following the Thanksgiving, Christmas, and New Year’s holidays,” Ari Houser, a senior methods adviser at AARP and coauthor of the analysis wrote. “We expect to see an additional surge over the next several months.”

Approximately 1,000 residents succumbed to the virus during the November period, marking a significant increase in fatalities, researchers said.

Since the onset of the pandemic in 2020, more than 185,000 nursing home residents have died from Covid-19, constituting roughly one-sixth of the nation’s total death toll. Despite representing less than 1% of the population, nursing home residents continue to be disproportionately affected.

The analysis showed a quadruple increase in infections among nursing home residents over the four-week period in November compared to the summer period. Approximately one in every 24 residents nationwide tested positive for Covid-19 during the recent period, with over a third of facilities reporting at least one resident case.

The surge in cases is not limited to residents alone. Infections among nursing home workers also quadrupled over the same time frame, with nearly half of all facilities nationwide reporting at least one staff case.

By state, Wyoming reported the highest infection rates among both residents and staff, while Alaska reported the highest death rate among residents. Virtually every state witnessed significant increases in infections and deaths compared to the summer period, with only Hawaii and Florida reporting decreases, researchers wrote.

Vaccination rates hit new lows

Despite the CDC’s recommendation of an updated Covid-19 vaccine for everyone aged 6 months and older, uptake among the nursing home population has been significantly lower than previous vaccines and boosters, researchers wrote.

As of November 19, only about a quarter of nursing home residents nationwide were up to date with the most recent vaccine, and a mere 7% of workers were up to date. In November 2021, almost 90% of residents were vaccinated, and roughly 40% were boosted. At that time, approximately 80% of staff nationwide were vaccinated, thanks in part to a federal mandate for nursing home workers.

Variations in up-to-date vaccination rates persist between states. Resident vaccination rates for the new vaccine ranged from a low of 10% in Arizona to a high of 55% in South Dakota. Worker up-to-date vaccination rates ranged from a low of 2% in Arkansas to a high of 18% in New Mexico.

“Nursing home experts say a mix of reasons is likely to blame for low up-to-date vaccination rates, including vaccine hesitancy, pandemic fatigue and confusion around what shots are needed,” researchers wrote.