Jto Phillips, a certified nursing assistant in a nursing home in Florida, loved her job but feared the danger of going to work in the pandemic. When vaccines became available in December, she got the chance to get one.
Months later, the danger seems to have faded. Following the introduction of Covid vaccines, the number of new cases of Covid among nursing staff has fallen by 83% – from 28,802 for the week ending December 20 to 4,764 for the week ending February 14, data show the Centers for Medicare & Medicaid Services.
New infections of Covid-19 among residents of nursing homes declined even more sharply during that period, by 89%, compared with 58% in the general public, according to the CMS and Johns Hopkins University.
These numbers suggest that “the vaccine appears to have a dramatic effect on reducing cases, which is extremely encouraging,” said Beth Martino, a spokeswoman for the American Health Care Association and the National Center for Assisted Living, an industry group.
“It’s a big relief for me,” says Phillips, who works at the North Beach Rehabilitation Center outside Miami. Now, she said, she is appealing to reluctant co-workers and anyone else to ‘take vaccination’.
After a brutal year in which the pandemic killed half a million Americans, despite unprecedented measures to combat its spread – including wearing a mask, physical distance, closing the school and economic closures – the vaccines give hope that a end is in sight.
National figures on healthcare worker infections in other environments are difficult to obtain.
Research in other countries suggests that vaccines have led to large declines in infections. A study of public hospitals in England indicated that a first dose was 72% effective in preventing Covid-19 among workers after 21 days and 86% effective seven days after the second shot.
Lost on the Frontline, a year-long data and reporting project by KHN and the Guardian, investigates more than 3,500 Covid deaths of U.S. health workers. The monthly number has decreased since December, but deaths often stay weeks or months behind infections.
Along with other health workers, nursing home staff and residents were the first to receive vaccinations in December, as elderly people in the community are one of the most vulnerable to infections: more than 125,000 residents died from Covid, according to CMS data, while more than 550,000 nursing home staff tested positive and more than 1,600 died.
Yet the vaccination rate among staff is much lower than that of residents. When the first clinics took place from mid-December to mid-January, a median of 78% of nursing home residents took a dose, while the median was only 38% for staff, according to the Centers for Disease Control & Prevention. Now, several nursing homes have said that the vaccination of staff has increased, based on informal surveys.
The uptake of vaccines by residents of nursing homes has been ‘very promising’, says Dr Morgan Katz, a specialist in infectious diseases at Johns Hopkins University, who advises Covid responses in nursing homes. “I think it’s a big contributing factor” to the decline in staffing, she said.
If you can slow down even one or two people who have been vaccinated in a building, it can accelerate.
Another factor, Katz said, is that ‘many nursing homes have already experienced major outbreaks – so there is likely to be a significant proportion of residents and staff who are already immune. ‘Also, Covid rates have fallen nationwide following an increase in holiday travel and gatherings in November and December, and thus staff members have less exposure in their communities.
But “although we see a wonderful turnaround in the number of cases,” she must remember that as long as staff are vaccinated 50 or 30%, they are still vulnerable, and that they are also incredibly vulnerable to long-term care residents. ”
Vaccination efforts are being rushed by the time as new Covid variants circulate and some states dramatically relax Covid’s limitations, making it easier for the virus to spread.
Distrust arouses hesitation against vaccine
The question of why some workers refuse the vaccine awaits. The New Jersey Veterans Memorial Home in Menlo Park experienced a major outbreak last year in which more than 100 employees contracted Covid and more than 60 residents and a certified nursing assistant, Monemise Romelus, died. Shirley Lewis, a union president representing CNAs and other workers, said it was traumatic. Only half of the workers there have taken the vaccine, Lewis said, and one is ill with Covid.
“Many of my members are not excited about taking this vaccine because they are scared,” Lewis said.
Some workers want to wait a little longer to see how safe the vaccine is, she said. Others tell her they do not trust the vaccines because they were developed so quickly, she said.
Other staff members “feel like it’s an experimental tool,” Lewis said, “because as you know, blacks, Latinos, other groups were used for experiments,” like the Tuskegee syphilis study, she said.
According to KFF, vaccine hesitation is higher among 30- to 49-year-olds, rural residents and black and Hispanic adults.
Certified nursing assistants, who make up the majority of long-term care workers, have historically been less likely to get flu vaccines than other health care workers, said Jasmine Travers, an assistant professor of nursing at New York University who studies vaccination hesitation. Nursing homes usually do not have nursing educators, which addresses workers’ concerns about vaccinations in hospitals, and CNAs also face structural barriers, such as limited internet access.
Nursing homes are usually hierarchies usually led by white staff members, while about 50% of the CNAs at the bottom of the power structure are black or Hispanic, she said.
With the Covid vaccine, some are afraid they will have to take sick time to miss work and do not want to tax their colleagues, who already have short staff, Travers said.
Deliberate misinformation
Low vaccination rates among long-term care workers nationwide have been a concern – so much so that LeadingAge, a national group representing long-term non-profit long-term care facilities, held a virtual town hall on March 4 on the safety of vaccine with the Black Coalition against Covid. 19.
The event, which attracted more than 45,000 viewers, was aimed at black long-term care workers.
Dr Reed Tuckson, co-founder of the Black Coalition Against Covid-19, said viewers expressed concern about fertility, pregnancy and contraindications. He said the event also had “many provocateurs” who insisted: “it’s all a myth, it’s all a lie.”
His group plans to hold more public information sessions for black audiences.
“There is no doubt that the three vaccines we now have available are extremely safe and extremely effective,” said Tuckson, a former public health commissioner in Washington.
The nursing home industry aimed to have 75% of staff nationwide vaccinated by the end of June.
Hesitation does not mean refusal
Most nursing homes have not been vaccinated, say industry officials, because they are afraid of losing staff. Since the vaccines were granted in an emergency, liability is also a concern.
According to Jun Lyn, Katzmann, president and CEO, Juniper Communities, which operates 22 long-term care facilities in four states and employs nearly 1,300 people, left 30 workers after being vaccinated.
Even when staff initially hesitate to take vaccines, “that does not mean it is a permanent refusal,” Travers said.
In southwestern Ohio, Kenn Daily runs two nursing homes run by Ayden Healthcare. About half of its staff and 85% of the residents had been vaccinated by mid-February, and they have had no case with Covid since. Still, he said, there is vaccine resistance among younger staff members who read misinformation online.
“Facebook is the object of my existence,” Daily said. Workers tell him that they are worried that they are going to make me microchips, or that the vaccine will change their DNA.
Now that time has passed since its initial implementation, Daily said: “I hope to put some pressure on my staff to act and vaccinate.”
His message: “It works, guys. It works very well. ”
Elizabeth Lucas, data editor of KHN, contributed to this report.
KHN (Kaiser Health News) is a national news agency that provides in-depth journalism on health issues. Together with policy analysis and survey, KHN is one of the three most important operational programs at KFF (Kaiser Family Foundation). KFF is a dedicated non-profit organization that provides information on health issues to the country.