Lower than expected vaccination rates among long-term care facility staff are an ongoing concern and a dark spot in the otherwise hopeful nationwide rollout of doses to the most vulnerable populations.
Residents of such facilities often have weaker immune systems and more underlying health issues than the general population. The needs of such residents, such as having medications delivered or needing help using the bathroom, can conflict with the need to isolate those who are sick. In November 2020, the previous presidential administration announced a federal partnership between facilities and pharmacies to provide doses to residents and staff.
A U.S. Centers for Disease Control and Prevention study of the federal vaccination program published last week showed that among nearly 11,500 skilled nursing facilities, between 61% and 93% of residents took the vaccine while between 23% and 57% of staff took the vaccine between Dec. 18, 2020, and Jan. 17, 2021.
The median figure for receiving the vaccination among skilled nursing facility staff was less than 40% in Tennessee, Georgia and Alabama, according to the CDC study.
Alice Bonner, who has worked as a geriatric nurse practitioner and is a member of the advisory council for the Center for Long-Term Care Quality & Innovation at the Brown School of Public Health, said the rates for staff "have been way too low. It's been 30 to 40 percent. We want those numbers to be higher because we want to get to herd immunity, we want to get as many people vaccinated as possible."
The vaccination rate among facility staff in Hamilton County remains unknown. On Feb. 3, the Times Free Press requested data from the Tennessee Department of Health about the facilities in Hamilton County participating in the federal vaccination program, how many residents and staff exist in each facility and how many have received first and second doses.
A spokesperson for the state acknowledged the request and said in an email the state would not be able to meet the initial deadline to provide the information. The Times Free Press requested the data again on Feb. 8 but a spokesperson from the state said in an email the request "requires a data extract from our system and we will provide it to you as soon as we can."
Why is data on Hamilton County vaccination rates not available?
The Times Free Press requested data from the Tennessee Department of Health related to vaccination rates in the county. The following question was sent to the state on Wednesday, Feb. 3:The data made available by CVS and Walgreens regarding COVID-19 vaccinations at SNFs/ALFS lists completed doses by state. I am requesting a list of all facilities in Hamilton County, Tennessee, that are participating in the program with CVS and Walgreens and the data on how many staff and residents exist in each facility, how many have received first doses and how many have received second doses.On Feb. 4, the state health department said it would not meet the Times Free Press deadline and the story was delayed pending the data.On Monday, Feb. 8, the Times Free Press again requested the data from the state health department, stating that if the information was not provided the newspaper would move forward with the story. The state did not meet the deadline, with a spokesperson writing in an email, “The information you asked for requires a data extract from our system and we will provide it to you as soon as we can. We appreciate your patience as our folks working on this request are also extremely busy with their daily COVID-19 duties and response.”When the Tennessee Department of Health makes the requested data available, the Times Free Press will report on it.
Bonner said the reasons for hesitancy among care facility staff mirror those of the wider population, including distrust in how the vaccines were developed or their safety. The scientific process to develop the available COVID-19 vaccines followed all the same safety protocols as other vaccines, but the production was faster since the manufacturing of doses occurred at the same time the vaccines were being developed, officials say.
Some people equate things they see on social media to information from reputable sources, such as the CDC or other medical experts, Bonner said.
A December 2020 survey by the Kaiser Family Foundation reported around a quarter of people in the United States were hesitant to get the vaccine, with higher rates of hesitancy among people ages 30 to 49, people who identify as Republicans and people living in rural communities.
Medical experts have said controlling spread in the surrounding community is important to protect residents since facility staff and visitors are the ones bringing the virus into the facilities.
Nearly a quarter of all deaths in Tennessee have been long-term care facility residents.
While the vaccination campaign brings some protection to thousands of vulnerable people, full protection takes several weeks after the second dose. Though the effectiveness of the vaccine in reducing the transmission of the virus remains unknown, a report from the American Health Care Association and National Center for Assisted Living found that in around 2,500 nursing homes studied those with a first-dose vaccine clinic had a 48% decrease in new cases among residents three weeks later, compared to a 21% decrease in facilities that have not had a first-dose clinic.
The state health department still considers Hamilton County facilities to be in the "red zone," requiring testing of staff twice a week since the seven-day average test positivity rate was 13.3%. More than a dozen facilities in the county reported a new COVID-19 case in the past 28 days.
The state publishes data every week about facilities that reported at least one new infection in the past 28 days. The list provides a glimpse at some of the outsized impacts of the virus on these communities. NHC HealthCare Chattanooga has reported 138 cases among its 165 residents, along with 24 resident deaths and 83 infections among staff. Similarly, at least 112 staff at Standifer Place have been infected with the virus and the facility has reported at least 20 resident deaths.
However, indicators continue to show the pandemic is slowing in Hamilton County and Tennessee. On Monday, the Hamilton County Health Department reported 85 new COVID-19 cases and 90 people hospitalized with the virus. The county is averaging 115 new cases a day in the past week.
In December, 92 of Tennessee's 95 counties had positivity rates high enough to need twice-weekly testing. This week, five counties had a low enough positivity rate to need testing once a month and 31 counties, including Shelby, Davidson and Marion counties, were recommended to test staff once a week, according to data from the Tennessee Department of Health.
Contact Wyatt Massey at wmassey@timesfreepress.com or 423-757-6249. Follow him on Twitter @news4mass.