Tennessee has among the lowest state vaccination rates for nursing home residents and staff, according to national data, and with the continued spread of the delta variant of COVID-19, gains made in opening such facilities for visitors may need to be scaled back.
This month, the average number of new cases rose more than 250% and test positivity rates doubled. On Tuesday, the Hamilton County Health Department added 122 new cases and 74 people were hospitalized with the virus. The county is averaging 81 new cases a day in the past week, the highest weekly average since Feb. 27, according to data from the department.
In the United States and its territories, Tennessee has among the lowest vaccination rates for nursing home facility residents and staff. Just over 76% of residents in Tennessee are vaccinated, the eighth-lowest percentage, and 47.8% of staff are vaccinated, the fifth-lowest, according to data from the Centers for Medicare & Medicaid Services.
This trend in Tennessee is playing out nationwide with vaccination rates among facility residents far outpacing rates among staff, said Dr. Morgan Katz, assistant professor of infectious disease at Johns Hopkins University School of Medicine. Low uptake among workers is putting residents at risk and slowing the process for reopening facilities to their pre-pandemic visitation policies, she said.
"Right now, a facility is considered in 'outbreak status' if one staff member tests positive," Katz said. "There's a significant number of unvaccinated staff, and they may have these sort of one-off cases and you may not see transmission from that, but because you're in an 'outbreak status,' it basically shuts down visitation to that facility."
Among the 11 nursing home facilities in Hamilton County tracked by CMS, just two facilities had a resident vaccination rate above 80% - Alexian Village with 92% and Woodland Terrace Care and Rehab with 80%. Not one of the 11 facilities had a staff vaccination rate above 70%, with the lowest rate being Life Care Center of East Ridge with 43% of its staff vaccinated.
In Hamilton County, 42% of residents had been fully vaccinated as of Monday, according to data from the county health department.
On Monday, more than 50 national medical groups - including the American Academy of Pediatrics, the National Hispanic Medical Association and the American Academy of Family Physicians - issued a joint statement calling on long-term care and other health care employers to require vaccines for staff.
"This is the logical fulfillment of the ethical commitment of all health care workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being," the statement reads.
Limiting the number of unvaccinated people in a long-term care facility and maintaining preventative measures, such as physical distancing, is the best strategy for limiting the spread of the virus, Katz said.
"I really encourage facilities to ask for voluntary evidence of vaccination status in all visitors," she said. "And, if they are not able to show that, then they should be considered unvaccinated. If they're considered unvaccinated, then all of the prior precaution - meaning masking, physical distancing, meeting in outdoor areas, not being able to walk through the facility - should really be in place for any unvaccinated visitors."
(READ MORE: Mask use to be encouraged, not required, in Hamilton County Schools this year)
In March, CMS updated its visitation guidelines for long-term care facilities to state that such facilities should allow visits at all times for all residents, regardless of vaccination status. However, CMS said visitation should be limited for unvaccinated residents when the county's positivity rate for new tests is about 10% and less than 70% of residents at the facility are vaccinated.
When a new COVID-19 case is reported in a facility, that operation should suspend all visitation until at least one round of testing is complete, according to the CMS guidelines. Visitation may resume if no additional cases of COVID-19 are detected in that round of testing.
With the spread of the highly contagious delta variant, local health officials are warning of a "third wave" of infections, hospitalizations and deaths from the virus. People who are fully vaccinated can still get infected with the delta variant, though their symptoms are generally milder and they are highly unlikely to be hospitalized or die from the virus, compared to unvaccinated individuals.
Bill Christian, a spokesperson for the Tennessee Department of Health, said the state wants local facilities to follow CMS guidance.
"We continue to encourage long-term care facilities to use the federal Centers for Medicare and Medicaid Services guidance regarding COVID-19 and share this information with residents, staff, family members and caregivers," Christian said.
There have been 41 resident COVID-19 cases and 50 staff cases in the past 28 days at long-term care facilities in Tennessee, according to data from the Tennessee Department of Health. Hamilton County facilities accounted for eight of those resident cases and two of the staff cases.
Will Brewer, vice president of corporate communications at Morning Pointe Senior Living, said the Ooltewah-based chain of care facilities was not planning to change its visitation policies in light of the recent rise of cases.
Morning Pointe operations in Tennessee, Alabama, Georgia, Indiana and Kentucky have limited indoor visits as long as the community does not have a recent positive COVID-19 case. All visitors must wear a face mask and be screened before entering, according to the company's website.
Life Care Centers of America declined to comment for this story. NHC HealthCare, Ascension Living and The Health Center at Standifer Place did not respond to requests for comment.
Contact Wyatt Massey at wmassey@timesfreepress.com or 423-757-6249. Follow him on Twitter @news4mass.