Low staff vaccination rates linked to more COVID-19 cases, deaths

Nursing home residents and workers have been hit hard by the COVID-19 pandemic. Vaccinating more employees appears key to stopping the spread in those settings, according to New England Journal of Medicine article published Wednesday.

Researchers reviewed COVID-19 case rates and deaths during a 10-week period this summer and concluded that 4,775 infections and 703 deaths would've been prevented over that time had more workers been vaccinated against the virus. They reported their findings in a letter to the journal's editor.

Nursing homes with the lowest staff vaccination rates had more than two times the number of COVID-19 cases and nearly three times the number of deaths among residents than those with the highest levels of staff vaccination, the researchers found.

Had all of the facilities with low levels of staff vaccination had rates matching the best-performing sites, 29% of residents' COVID-19 cases and 48% of deaths recorded between June 13 and August 22 might have been avoided, the research shows.

"The results are pretty clear that staff vaccination matters. It matters even when you have residents who, as a group, are highly vaccinated and you have additional measures in place like a requirement to mask and surveillance testing," said Brian McGarry, professor of geriatrics and aging at the University of Rochester and one of the paper's authors.

Nursing homes have struggled to persuade employees to get COVID-19 shots, relative to other healthcare employers. The federal government attempted to ramp up healthcare worker vaccinations through a Centers for Medicare and Medicaid Services mandate for Medicare and Medicaid providers, but a federal judge blocked the regulation last week while a legal challenge proceeds.

Researchers used CMS data from 12,364 nursing homes to account for county-level COVID-19 spread, resident vaccination rates, previous infection rates among residents and staff, and facility characteristics.

Nursing homes have used methods like educational sessions and one-on-one meetings with hesitant workers but are running out of ways to cajole holdouts to get vaccinated, McGarry said. "It really takes a mandate. It takes a requirement," he said. The people still resisting the vaccine are the hardest to convince and the methods already tried haven't worked, he said.

Under the federal vaccine mandate, employees needed to receive their first COVID-19 vaccine dose by Dec. 6 and be fully vaccinated by Jan. 4. Although the federal rule is on hold, several states separately have required inoculations for healthcare workers.