Mobile Population Tests Phased Vaccine Strategy for Nursing Homes in Connecticut

At every nursing home in Connecticut in January, between 90 and 100 percent of residents received a COVID-19 vaccination, according to the state Department of Public Health, vaccinations that greatly slowed the spread of the virus within each facility.

In the last three weeks of January COVID-19 cases reported in nursing homes declined by 66 percent, according to the state Department of Public Health.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has estimated that herd immunity requires about 75 percent of a population to be vaccinated.

But as the state begins phase 1b of vaccinations — with eligibility gradually extending to everyone over the age of 65 — epidemiologists warn that the state’s success could be fleeting, given the highly mobile populations of patients and workers at nursing facilities. 

“Yes, we have great rates now, but in a month from now we could be down to 75 percent and then we could be down to 35 percent four months from now,” said Jim Hadler, an infectious disease epidemiologist at Yale School of Public Health. 

Hadler warned that the nursing home population is incredibly transient between departures for increased care at the hospital and short term stays after surgeries and other procedures. 

“The state is aware of it now, but didn’t think about this originally,” Hadler said. 

Only about 50 percent of current staff at nursing facilities opted to receive the vaccine during phase 1a in January, lowering the total vaccination rate of the setting and leaving an opportunity for the virus to be reintroduced into the population.  

“The majority of staff were reluctant to get it, they want to see it in use longer,” Hadler said. “The only problem with that is I don’t know where they’re going to get it the next time around.” 

Maura Fitzgerald, a spokesperson for the Department of Public Health, said the department is now working to address the potential problem.

“We are actively engaged in discussions with federal agencies and our federal pharmacy partners to plan for future vaccination needs at our skilled nursing and other long term care facilities once the third round of vaccine clinics are complete,” said Fitzgerald. 

She said that by the time the currently planned vaccinations are complete, the department will have a plan in place to address the vaccine needs of new residents coming into our long term care facilities.  

Testing and isolation measures

After a great number of cases and deaths from COVID-19 in nursing facilities at the start of the pandemic, over the last 10 months nursing homes in Connecticut have put many other measures into place that have helped reduce the transmission of COVID-19 between residents and staff.

“The key thing that has been very helpful compared to last spring is routine testing,” Hadler said. “Nursing homes are watching people who are transferred in or go out for appointments. It doesn’t eliminate the potential for it to be introduced, but recognizing it immediately makes all the difference.” 

According to Mairaid Painter, the Long Term Care Ombudsman for the state, all nursing home residents and staff are tested twice a week with both the antigen test and the PCR test. 

“The antigen test is a way to help isolate people sooner,” she said. “They started using that more readily in mid-fall and it is the primary way we’ve been able to stop the spread throughout a home.” 

All new residents and any resident who has tested positive is now transferred to an observation unit for two weeks until they have two negative tests. 

Choosing a nursing home

As families try to choose the safest option for loved ones needing nursing care, the public has benefitted from reports of active cases and the results of routine inspections and nursing facilities.

But Painter warned that some data – in particular, deaths due to COVID — have been more confusing than helpful.

“The deaths linger,” she said. “A nursing home may have had positive tests as far back as this fall and the deaths are showing up in this week’s report.”

Families are faced with what appears to be conflicting information, when the state is reporting multiple deaths at a facility the same week as they are told there are no COVID cases. 

“People are depending on accurate data and accurate reporting to make a decision, and even if these deaths occurred in the hospital months after the individual left the nursing home it shows up as a nursing home death in that facility this week,” Painter said. 

Painter said the only way families can be sure they are getting the most up-to-date information is by calling the nursing home directly. 

“I think it’s still scary for families to have a loved one in a nursing home, but we are in a better place than we were months ago,” Painter said. “Even when there is an outbreak, the ability to test, respond, cohort … this has really decreased the outbreaks and decreased the number of people who have passed away due to the outbreaks.”

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