A quarter of Massachusetts nursing homes have faced COVID-19 outbreaks in recent weeks, and most of the cases have been spread to residents from staff, state health officials revealed during a tense briefing with industry representatives Thursday.
Nursing homes were ground zero for the first wave of COVID-19 in 2020, as residents died by the hundreds, spawning a massive campaign to immunize them against the virus. Today, 89 percent of Massachusetts nursing home residents are fully vaccinated.
Yet, 18 months into the pandemic, COVID-19 is coming back in Massachusetts nursing homes, though — so far at least — most cases seem to be mild.
The revelation comes in a week when the Baker administration ordered nursing home workers to be vaccinated by Oct. 10. But some industry leaders say that the mandate doesn’t go far enough and leaves frail residents still too exposed to the virus.
“We don’t care for our patients in a bubble; they go out to dialysis, they go to doctors’ visits, and they are often hospitalized. There are so many touchpoints in their lives we don’t have control over,” Dr. Larissa Lucas, who serves as medical director for six nursing homes through North Shore Physicians Group, said in an interview after the briefing.
“I am in full support of mandatory vaccination for health care workers and this was a bold and very brave step on the part of” the state health department, Lucas said. “Unfortunately, it won’t be effective if the rest of the health care industry doesn’t step up to protect the frailest in our community.”
The state mandate only applies to nursing home workers, yet residents in these facilities may be exposed during outside medical appointments to countless other health care workers who have not been vaccinated.
While just 11 percent of Massachusetts nursing home residents remain unvaccinated, fully a quarter of staff have not received shots, state data show. In the United States, the failure of many nursing home staff members to get vaccinated is raising alarm, as memories of dark days last year are still fresh: One-quarter of the pandemic deaths in the country had occurred in nursing homes as of June.
In the past four weeks in Massachusetts, 57 facilities reported two or more cases among staff and residents, for a total of 170 cases — 88 among staff and 82 among residents, health department officials said during the briefing. At least an additional 50 facilities have also reported at least one infected staff member.
“A large number of resident cases were in fully vaccinated people, but the majority of staff cases were in unvaccinated individuals,” said Melissa Cumming, an epidemiologist with the state Department of Public Health.
She said most who have recently tested positive and are fully vaccinated have had mild or no symptoms. Officials did not share data on recent hospitalizations or deaths.
The sharp rise in cases prompted state officials to issue additional mandates for nursing homes, such as a requirement that everyone, including staff, visitors, and contractors, wear masks indoors again, even if they are fully vaccinated. It grants exceptions for resident dining and group activities, but only if all participants are fully vaccinated.
Some nursing home leaders raised concerns during the briefing about large numbers of visitors who are not vaccinated, and asked if they could require vaccination or rapid testing for infection before such visits.
But Massachusetts health officials quickly nixed that idea, saying they had been advised by federal officials earlier in the week about creating hurdles for visitors. State officials also said they had not recorded any transmission of infections from visitors, that it has primarily been spread by staff to residents.
“You can not require testing or vaccination of visitors. ... That was made clear by [federal regulators], that’s not permissible,” said Sherman Lohnes, director of the health department’s Division of Health Care Facility Licensure and Certification.
Yet, hours later on Thursday, the California Health Department did just that, directing hospitals, nursing homes, and intermediate care facilities to verify that visitors are fully vaccinated or have tested negative for COVID-19 in the 72 hours before indoor visits.
While more health care facilities and nursing homes have mandated COVID shots for workers, some Massachusetts nursing homes had been reluctant to order staff to get vaccinated for fear of exacerbating an already serious staff shortage.
The state’s new rules include a $50 per day penalty against a nursing home for each member of a facility’s personnel who is not fully vaccinated. The rules also allow the state to freeze admissions to any facility that doesn’t ensure at least 75 percent of its staff is fully vaccinated by Oct. 10.
Dr. Asif Merchant, medical director at four nursing homes in the Metro West area and chief of geriatric medicine at Newton-Wellesley Hospital, said the rules leave a loophole that may encourage staffers who don’t want to get vaccinated to quit and join a temporary nursing agency that doesn’t mandate shots. Those agencies often pay considerably higher wages to temp workers sent to the very homes staffers have just left.
“I think [state officials] took a good first step in mandating shots, but they have to think this through a little more carefully about how this affects agency staffing companies, assisted-living units, and dialysis centers,” Merchant said.