Nursing Homes, Once Hotspots, Far Outpace U.S. in Covid Declines

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By Matthew Conlen, Sarah Mervosh and Danielle Ivory, New York Times, February 25 2021

Throughout the pandemic, there has been perhaps nowhere more dangerous than a nursing home. The coronavirus has raced through some 31,000 long-term care facilities in the United States, killing more than 163,000 residents and employees and accounting for more than a third of all virus deaths since the late spring.

But for the first time since the American outbreak began roughly a year ago — at a nursing care center in Kirkland, Wash. — the threat inside nursing homes may have finally reached a turning point.

Since the arrival of vaccines, which were prioritized to long-term care facilities starting in late December, new cases and deaths in nursing homes, a large subset of long-term care facilities, have fallen steeply, outpacing national declines, according to a New York Times analysis of federal data. The turnaround is an encouraging sign for vaccine effectiveness and offers an early glimpse at what may be in store for the rest of the country, as more and more people get vaccinated.

From late December to early February, new cases among nursing home residents fell by more than 80 percent, nearly double the rate of improvement in the general population. The trendline for deaths was even more striking: Even as fatalities spiked over all this winter, deaths inside the facilities have fallen, decreasing by more than 65 percent.

“I’m almost at a loss for words at how amazing it is and how exciting,” said Dr. David Gifford, the chief medical officer for the American Health Care Association, which represents thousands of long-term care facilities across the country.

“If we are seeing a robust response with this vaccine with the elderly with a highly contagious disease,” he said, “I think that’s a great sign for the rest of the population.”

Experts attribute the improvements in large part to the distribution of vaccines. About 4.5 million residents and employees in long-term care facilities have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention, including about 2.1 million who have been fully vaccinated.

Other factors, including the steep drop in new infections nationwide in recent weeks, may have contributed as well.

Today, new cases in American nursing homes are at their lowest point since May, when the federal government began tracking such data.

“What is certainly surprising to me is how quickly we’re seeing this,” said Dr. Sunil Parikh, an associate professor of epidemiology and medicine at Yale School of Public Health in Connecticut, where weekly cases in nursing homes had dropped from several hundred around the holidays to as little as 30 statewide during one recent week.

“It’s a dramatic decline,” he said, adding that more research was needed to determine what role community transmission played and whether the first dose of vaccine may offer more protection than previously thought.

In one promising sign, the American Health Care Association, the industry group, looked at nearly 800 nursing homes that received early doses of the vaccine in December and compared caseloads with facilities in the same counties that had not yet held a vaccine clinic. The nursing homes that got the earlier vaccine saw a 48 percent decline in cases among residents, compared with 21 percent among nearby nursing homes.

In some nursing homes, four out of five residents or more have now been vaccinated. Some states, such as Connecticut and West Virginia, have reported finishing vaccinations at all nursing homes, but many employees and a smaller share of residents nationally have declined to get the shot.

At Valley Senior Living in Grand Forks, N.D., more than 90 percent of residents agreed to be vaccinated. The high rate of uptake, combined with low levels of community transmission, has meant that life is slowly inching back to normal for the 400 or so people who live in the facility’s nursing and assisted living centers.

Residents are now allowed to visit with loved ones again, one or two people at a time. They are singing in choirs, albeit masked and spaced apart. There was even a recent Mardi Gras parade, complete with beads and music. It is a marked change from much of the past year, when outbreaks there led to months of shutdown and at least 12 deaths.

“Things are better,” said Garth Rydland, the chief executive at Valley Senior Living. “You kind of knock on wood every time you say something like that, but now, I feel a lot more confident.”

Note: State and local governments often revise data or report a single-day large increase in cases or deaths from unspecified days without historical revisions, which can cause an irregular pattern in the reported national figures. The Times is excluding these anomalies from weekly averages when possible. Read more about the data here.