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Outbreaks continue in some Oregon senior care homes after vaccination clinics. Why?

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Staff at Rose Villa Senior Living in Oak Grove, just outside of Portland, wait and watch as the first Pfizer coronavirus vaccines arrive on December 21, 2020.
Staff at Rose Villa Senior Living in Oak Grove, just outside of Portland, wait and watch as the first Pfizer coronavirus vaccines arrive on December 21, 2020. Photo Gallery

More than a dozen Oregon senior care homes have reported coronavirus outbreaks even after staff and residents were offered vaccines, The Oregonian/OregonLive has found, pointing to the reality that vaccine access, while extraordinarily important, has not been a panacea for completely ending some outbreaks.

At one facility, a resident got sick and died with COVID-19 more than two weeks after getting both shots of the vaccine, a facility director said.

In another, most of the 13 staff who tested positive had refused to get vaccinated.

In a third facility, seven people tested positive after they should have reached full immunity – triggering reports to the state and federal government in search of potential variants of the disease.

In all, at least 15 nursing, assisted living and memory care homes in Oregon have seen coronavirus outbreaks weeks after residents and staff were offered shots, three of them exceeding 30 cases. New cases continue to emerge.

To be sure, the research and federal data indicate the coronavirus vaccine has almost certainly helped reduce coronavirus cases and deaths in senior care homes since doses became available in December. In Oregon, new nursing home cases have dropped to their lowest point since the pandemic began, federal data show, mirroring a nationwide trend.

So, if vaccines are working, why are some nursing homes still seeing outbreaks?

The answer is that, to a degree, post-vaccination clinic outbreaks are to be expected – either because of low vaccine uptake among residents or staff, partial immunity because not enough time has elapsed or virus variants less susceptible to vaccines. Moreover, the vaccines were never billed as being 100% effective, and facilities test workers and staff frequently, making it easier to identify cases among people without symptoms.

The outbreaks highlighted by the newsroom do not indicate the vaccine is not working but instead raise questions about the underlying circumstances and details of the eruptions.

However, without the kind of individual-level data only public health officials and researchers could have access to, it’s impossible to know important details that would better help shape the public’s understanding of these outbreaks.

For example: How many people in Oregon’s senior care home outbreaks were fully vaccinated before they got sick and, if they were, how much time had elapsed after their most recent dose?

The Oregon Health Authority said it is collecting data on vaccination status among residents and staff who have tested positive for COVID-19. The agency did not say if it is performing any analyses on the data, though it is sending information about those who tested positive after reaching full immunity to federal health officials.

The agency did not provide the number of outbreaks that occurred after vaccination clinics or the number of senior care home cases among people who reached full immunity.

Examining such cases can help identify problems during shipping, storing or administering the vaccine, a spokesman for the agency said.

The agency also pointed to the fact that the real-world effectiveness of vaccines might not be the same as what pharmaceutical companies found when doing their research. That could be particularly true when it comes to seniors.

Residents in long-term care “make up a special population of increased concern for vaccine failure, both because this population may not mount a robust immune response and is at higher risk of developing severe illness from COVID-19,” spokesman Timothy Heider said.

The agency is helping analyze samples of the virus to identify mutations that can get around defenses the vaccines are meant to create.

Long-term care homes have served as a type of bellwether for the rest of the population during the COVID-19 pandemic, said Benjamin Clark, a University of Oregon public policy professor who has authored reports on the state’s coronavirus response. He said it’s important to understand why outbreaks continue to occur in the facilities even after vaccines.

Coronavirus hits senior care home residents harder and earlier than others, making them potential predictors of the course of the pandemic.

Continued outbreaks, however less frequent than at the height of the pandemic, may point to uncertainty for the future, how long it will take before senior care home restrictions can be fully lifted or how safe residents and staff will be going forward.

Because most of the residents and staff in care homes have had the opportunity to get vaccinated, how they fare could help predict how the rest of the population will once everyone can get the vaccine, Clark said.

“If that population is doing phenomenally better, then we would expect the rest of the population to be doing phenomenally better” and vice versa, Clark said. “That population will be the leading indicator of the change towards good or bad outcomes.”

In investigating post-vaccination cases, local, state and federal health officials have prioritized identifying mutations of the virus that can get through the defenses afforded by vaccines. But other, no less threatening, reasons can explain continued outbreaks, the newsroom found.

Variants, low vaccine uptake and partial immunity mean that ending pandemic will still take time, said Dr. Thomas Russo, an infectious disease expert at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.

“There’s always some risk,” Russo said, “in the age of COVID.”

A Harney County care home’s recent experience illustrates that vaccines are only effective if people take them.

While many Oregon care homes have had multiple outbreaks, The Aspens Living Center, in Hines, hadn’t identified a single case in one year of pandemic. By January, it seemed like the facility was in the final stretch, with pharmaceutical company employees setting up shop and offering everyone a shot of the coronavirus vaccine.

Then, something strange happened.

Just three of the 25 employees and 20 of the 38 residents agreed to get a shot. Staff and residents were worried about vaccine side effects, said Ryan Dupuy, the facility director.

The facility had its first positive case five weeks later, setting off a cascade of infections that hospitalized two residents and forced just over half of the facility’s staff to stay home due to infections.

“I figured eventually there would be a case, but not necessarily this bad,” Dupuy said.

Dupuy is sure that had more people gotten vaccinated, the outbreak would have been less severe, even if everyone wouldn’t have reached full immunity by the time the virus began spreading.

“I would’ve loved if everyone had gotten the vaccine,” he said.

Indeed, low vaccine uptake among senior care home workers has been a problem nationwide, with one study reporting less than half of nursing home staff offered vaccines took them.

Officials and facility administrators have said young staff have been particularly hesitant, preferring to wait to see how their colleagues fare in the longer-term before deciding to get a shot.

The state doesn’t track how many of the long-term care staff and residents who are offered shots accept them, a spokeswoman for the Department of Human Services said.

In Douglas County facilities with outbreaks, only about half of the staff got shots, county Public Health Officer Dr. Robert Dannenhoffer said.

“If all the staff were vaccinated, an outbreak wouldn’t be impossible,” Dannenhoffer said. But it would be “much less likely.”

But even getting a shot far from guarantees outbreaks won’t happen.

Anecdotal examples relayed by facility managers show that some long-term care staff and residents did test positive – and in some cases die with COVID-19 – after getting one or more doses of the vaccine.

Indeed, at least six Oregon facilities with post-vaccination clinic outbreaks had cases among people with some or full immunity.

Two people who tested positive and died with COVID-19 symptoms in a recent outbreak at Life Care Center of McMinnville had at least one shot, said Kristy Runge, interim director of nursing. One of them tested positive 15 days after getting the second dose of the vaccine.

Separately, a resident and worker at the facility got sick more than 10 days after the second dose, prompting health officials to test for a variant, Runge said.

The samples were sent out Feb. 15, Runge said, and results have not yet returned.

While she would like to see the results, Runge said the vaccine has apparently made a difference. The two surviving cases after being fully vaccinated had mild symptoms and have completely recovered, she said. And, across the board, residents appear to feel safer now that most people have been vaccinated, she said.

“There definitely is, for the residents, a different level of comfort,” Runge said.

Post-vaccination immunity is on a spectrum, from zero immunity with no vaccine at all, to some immunity after one dose, to the highest level of immunity a few weeks after the second dose.

One recent real-world study in Israel found that one dose of the Pfizer-BioNTech vaccine was 57% effective in preventing COVID-19, and two doses were 95% effective.

An American Health Care Association analysis of federal vaccination and outbreak data found a 48% reduction in cases among facilities with at least one clinic, compared to a 21% drop among those that did not. Most facilities saw a reduction because of a general downward trend.

Partially immune people provide a perfect breeding ground for new variants to appear, said Oregon Health & Science University researcher Dr. Ben Bimber.

A fully vaccinated person might be able to fight off all varieties of the virus right away, but those who have had only one dose might not have a strong enough response to eliminate more evasive variants of the virus.

“We need to be studying them very carefully,” Bimber, who helped identify Oregon’s first coronavirus variants, said. “They represent cases where the vaccine did not work.”

Others are less interested. Health officials for the Multnomah County health department, for example, say that the risk of disease before maximum immunization is known and therefore such cases are insignificant.

“There’s nothing really to look at” if it’s been less than two weeks after the second dose, said Lisa Ferguson, a county communicable disease manager with the county. “Because we know they do not have adequate immunity.”

Health officials are also trying to identify and study variants of the coronavirus that can infect even those who have received shots. At least 18 Oregon coronavirus cases have been discovered with variants from Brazil and the United Kingdom.

Vaccines were originally made based on the virus first identified in China, and scientists are concerned that those vaccines could be less effective against mutated versions of the virus. But evidence suggests existing vaccines reduce the severity of illness, and the vaccines can be tweaked as more is known about the variants.

While the Oregon Health Authority has said vaccines are likely to reduce the severity of variant infections, “it is too early to speculate” how effective the vaccines will ultimately be against them.

One known case of a variant infection after full vaccination occurred in an Oregon “health care setting,” according to researchers with Oregon Health & Science University who identified the variant, though they did not know if that was a long-term care facility.

Dannenhoffer, the Douglas County health official, is worried he could have a variant outbreak on his hands.

One facility had seven so-called “breakthrough” cases of people getting infected after being fully vaccinated, he said, and he is still waiting on the results of a genetic analysis to find out if those people were, in fact, sick with a newer version of the virus.

Dannenhoffer said he is expecting the results “any day now.”

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