FORT LAUDERDALE, Fla. — When COVID-19 vaccines arrived in Florida in December, seniors in elder-care facilities were among the first to get the life-saving treatment.
The strategy has paid off: COVID-19 cases in residents of Florida nursing homes and assisted living facilities fell 90% since January.
Now senior advocate organizations are closely watching the new case numbers and hospitalizations. No one — even vaccine manufacturers — knows for certain how long immunity will last, particularly in the elderly. Pfizer and Moderna CEOs have said it’s likely there will be a need for a third dose, somewhere between six and 12 months.
“It’s a critical juncture,” said Brian Lee, director of Families for Better Care. a nonprofit watchdog organization for long-term care facilities.
Lee worries health officials aren’t paying close enough attention in this population in which COVID-19 has proved deadly. The Florida Department of Health has not updated the number of cases and deaths in long-term care residents and staff on its public-facing dashboard since May 5, he said.
“It’s important to know how the trajectory is shifting in these facilities. They are the most vulnerable and the time frame is narrowing. If they got a Moderna or Pfizer vaccine, they might need a booster,” he said. “June is coming and for many, it will be six months since they were vaccinated.”
For now, the Florida Health Care Association, the state’s largest advocacy group for nursing homes, said it is focusing on getting all residents and staff vaccinated with the two doses they need to have initial immunity.
Over the last six weeks, the vaccination rates have barely budged, particularly among staff members — which is how the virus initially seeped into facilities.
About 74% of nursing home residents are vaccinated, up from 68% six weeks earlier. About 93% of assisted living residents are vaccinated, which did not change.
For staff, vaccination rates remain dangerously low — only about 40% of nursing home staff (up from 36%) and 43% of assisted living facility employees (up from 40%) have received a shot, according to the Agency for Health Care Administration.
Without everyone becoming vaccinated, COVID-19 has crept into some facilities. As of Monday, three dozen facilities in Florida have residents with COVID-19, and nearly 200 senior-care centers have one or more staff members with the virus, data provided to The South Florida Sun Sentinel shows. Some of those facilities have dedicated COVID-19 units that house as many as 18 positive residents. Others have small outbreaks with as many as 10 staff members infected.
“You only need one symptomatic or pre-symptomatic person to go in and out for them to spread the virus to multiple residents who aren’t vaccinated yet,” said Jeff Johnson, Florida director of AARP. “Infection control is incredibly important in nursing homes and something they have a spotty record on.”
In the last few weeks, health officials ended weekly COVID-19 meetings with long-term care owners, and most nursing homes pulled back significantly on their routine testing, following new federal requirements.
The majority of Florida’s nearly 4,000 eldercare facilities are COVID-19 free, but Johnson said only close monitoring and regular testing will ensure that continues.
New federal guidelines allow nursing homes to test staff only monthly when the positivity rate in the community is less than 5%. Vaccinated staff and residents don’t need to be tested at all unless they have COVID-19 symptoms or a case in the facility arises.
“All of us are pleasantly surprised at how effective the vaccines have been,” Johnson said. “But if there becomes a need for a booster, I think we are going to see it first in those who were first vaccinated and most vulnerable. No one seems to be focused on planning for when that happens.”
Public health experts say as long as the virus circulates, it will be a threat to elderly seniors, and that may continue through 2021.
“Elderly people, the very people we have gone through economic shutdowns to protect, generally don’t hold on to their immunological protection as well as younger individuals,” Dr. Michael Mina, an epidemiologist at Harvard T.H. Chan School of Public Health, said during a recent town hall. “I would be very surprised if we don’t see a resurgence of cases, in a much smaller degree, this fall and winter. Those will end up getting into some of the senior living centers and nursing homes and we will see additional cases that are very worrying.”
Dr. Tamara Konetzka, a professor of health services research at the University of Chicago, has studied the effects of COVID-19 on nursing homes. She found the level of COVID-19 spread in a community is a predictor of nursing home cases and deaths. Konetzka believes getting more people vaccinated is more of a priority than a booster for the elderly.
“The best way to protect nursing home residents is to keep down rates of COVID-19 in the community,” she said.
New cases in long-term care residents have declined each month since January, and facility managers attribute that to vaccines. But some elderly residents are unable to get vaccinated, which is why getting staff fully vaccinated, requiring protective gear and continuous testing is critical — as is keeping vaccinated residents’ immunity levels high.
At John Knox Village in Pompano Beach, Mark Raynar, director of the skilled nursing center, says he is watching his residents closely and awaits news of a booster. The seniors at the sprawling John Knox community were among the first in the state to get vaccinated in December.
But for now, vaccines are working, Raynar said. Even when three of the village’s residents who were vaccinated recently tested positive for COVID-19, their cases were mild, he said.
“The good news is that the vaccine did work,” he said.
After six on-site clinics, however, only 40% of the John Knox staff is vaccinated, he said. “Our goal is 100% and we know we have to do that through extensive education.”
Raynar said Florida’s emergence from the pandemic is closely tied to how much support senior communities like John Knox receive with keeping COVID-19 out. “It’s about tracking the virus closely and making sure we are putting seniors first,” he said.
Consulate Health Care operates 80 senior living centers in Florida. About a dozen of their facilities have clusters of infected residents and staff members or both, and a few locations have COVID-19-only units with more than 10 in each, state records show.
Spokeswoman Jennifer Trapp said Consulate knows that getting more staff vaccinated will be significant for keeping the virus and possible variants out. “The reality is that it’s hard,” she said. “There’s a lot of reluctance.”
While each operator in the state fights that battle, Trapp said all they can do is hope the high level of immunity in vaccinated residents continues to last.
“We are grateful the federal government recognized the need and made us first in line for the vaccine,” she said. “If we find a booster is necessary, we think they have set the precedent that we will be first in line for that to happen.”