Lagging recall rates raise fears of a deadly winter in nursing homes

COVID-19 infections and hospitalizations are on the rise, posing a major threat to nursing home residents and staff who are not up to date with their COVID-19 vaccinations.

According to federal data, less than half of all nursing home residents and less than a quarter of staff have received a bivalent booster shot. As the colder months approach, low vaccination rates portend a harsh and potentially deadly winter.

Hospitalizations are up more than 25% in the past two weeks, driven primarily by older Americans and those with underlying health conditions.

Nursing home residents and staff are particularly susceptible to COVID-19 infection; one-fifth of all COVID-19 deaths in the United States have occurred among residents and staff of long-term care facilities, according to the Kaiser Family Foundation (KFF).

A KFF analysis of federal data showed that just 45% of nursing home residents and 22% of staff were up to date with their COVID-19 vaccines just before Thanksgiving. The rates are much higher than the general population, but much lower than the industry would like.

“It’s a surprising finding because such a high share of residents have received their primary vaccine series,” said Priya Chidambaram, senior policy analyst at KFF and one of the authors of the analysis.

“The national story seems to be that the rates are pretty low,” Chidambaram said.

Nursing homes saw a spike in deaths after the holidays last year. Chidambaram said the death rate has risen from 35 deaths per 100,000 people in mid-November to 131 deaths per 100,000 in mid-January 2022.

“The risk is that people will get very sick and die,” Chidambaram said.

The elderly population is also most at risk from other respiratory viruses like influenza and respiratory syncytial virus, which are seeing extremely high rates of transmission much earlier than in previous years and are straining hospitals across the country. .

These viruses can compound the risks of COVID-19, which is why health experts have said it’s crucial that nursing home residents and staff are up to date with their vaccinations.

“The prospect of not being able to get into a hospital when you need to is scary,” said Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes. “We’re dealing with flu season colliding with the holidays, and it’s the perfect storm.”

The Biden administration recently launched a year-end sprint to improve lagging COVID-19 vaccination rates, with a focus on nursing facilities.

The new combination booster targets both omicron and the original strain of the virus, and recent research has shown that it may provide protection against the new omicron subvariants currently in circulation, which are proving particularly capable of escaping immunity.

But experts and industry groups said the hurdles facing care homes haven’t changed since the first round of recalls last year, including pandemic fatigue, mixed messages about vaccine effectiveness and the strict requirements for administering the vaccine.

“It’s incredibly disheartening to see such low rates given all the effort we’ve made to try and get these populations vaccinated and stimulated, and just given the risk they face,” said David Grabowski, professor health care policy at Harvard. Medicine School.

Grabowski said the Biden administration’s vaccination mandate for nursing home staff was a major factor in getting high vaccination rates initially. But he lamented that the mandate had not been updated to include the bivalent recall.

Industry groups are asking the White House to help them with an “all on deck” strategy, but they are not asking for an updated mandate.

They want the administration to update their posts on what bivalent recall can and cannot do. Specifically, they want to emphasize that the recall helps prevent serious illness, hospitalizations, and deaths, not that it prevents infection or the spread of COVID-19.

“I think there is some confusion and misunderstanding about the value of the vaccine. At the beginning we talked about it to prevent infections, and therefore [residents] see breakthroughs [infections] and wonder if it really works,” said David Gifford, chief medical officer of the American Health Care Association.

“There is a lot of vaccine fatigue out there. I think it’s very important for us to be very clear in our communications about what dual-use recall does,” said Smith Sloan of LeadingAge. “I actually think that message is very powerful; who wants to be seriously ill?

But Grabowski said he was skeptical that education alone would do much to increase the use of reminders.

“I’m sorry, it’s just not good enough at this point. It’s not going to move the needle much in my opinion. There’s not a lot of effort to go out there and enforce that or set up clinics in the facilities themselves,” Grabowski said.

Industry groups want to make it easier to administer vaccines on site. For the primary series, the federal government sponsored three on-site vaccination clinics at all long-term care facilities that participated in a pharmaceutical partnership program.

But nursing homes must now request special clinics, rather than relying on their own long-term care pharmacies as they do for flu shots.

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