On the surface, the news sounds alarming: More than half the residents of a Kearney nursing home recently contracted COVID-19, even after the vast majority already had been vaccinated.
But rather than casting doubt on the effectiveness of vaccines, the unusual outbreak at the central Nebraska care facility stands as proof that shots work.
While 23 residents tested positive for the deadly virus, only two ever showed any symptoms, which were mild and quickly cleared.
In short, the vaccinations protected the home’s vulnerable residents.
“Overall, the vaccine did what it was supposed to do: It prevented severe disease and prevented people going to the hospital,” said Dr. M. Salman Ashraf, who as medical director of the Nebraska Infection Control Assessment and Promotion Program works with care facilities to prevent and contain virus outbreaks.
The early April outbreak at the Good Samaritan Society-St. Luke’s facility in Kearney is one of only two large nursing home outbreaks documented nationally in the wake of widespread nursing home vaccinations. The U.S. Centers for Disease Control and Prevention on April 21 issued a report on a similar outbreak in Kentucky.
Health officials say the two outbreaks show the importance of convincing hesitant nursing home workers to get vaccinated. It’s believed the Nebraska and Kentucky outbreaks were precipitated by unvaccinated workers bringing the virus into the homes.
Many facilities across the country have struggled to get staff to take the shots. A CDC study in February found that during the first round of vaccinations, an average of almost 80% of residents took the shots, while less than 40% of staff did.
There also are broader lessons from the two outbreaks that go beyond care facilities.
It has been known from the start that people getting vaccinated still can contract COVID-19, and even get seriously ill and die. That’s because vaccine trials had shown the shots were more than 90% effective in preventing symptomatic infection, but not 100% effective. A case in which a vaccinated person tests positive for the virus is known as a “breakthrough.”
Due to the chance of breakthroughs, the CDC has been recommending that those who have been vaccinated continue to take precautions such as wearing masks in indoor public places, socially distancing and avoiding crowds and confined spaces.
But figures from both the CDC and Nebraska Department of Health and Human Services show that more than four months into the vaccination campaign, breakthroughs are extremely rare.
The cases in Kearney are among a total of 287 possible vaccine breakthroughs identified statewide as of April 28. Considering more than 600,000 Nebraskans are now fully vaccinated, those breakthroughs represent just 5 one-hundredths of 1% of those vaccinated.
The CDC has said many breakthrough cases — just like most of those in Kearney — don’t result in symptoms at all.
Officials with Good Samaritan Society-St. Luke’s said they feel “blessed” by the positive outcomes for their residents that appear to be due to the vaccinations.
“We are thankful to everyone who has chosen to protect themselves and others by getting the vaccine,” said home administrator Shawn Leach. “Please encourage your friends and loved ones to get vaccinated if they haven’t already done so, to help contribute to the protection of our most vulnerable friends and neighbors.”
During the yearlong COVID-19 pandemic, nursing home residents have paid a very steep price. When the virus gets into facilities where medically fragile individuals live in a communal setting, the results often are devastating.
In Nebraska, more than 800 nursing home residents have died after testing positive for COVID-19, accounting for roughly one-third of all deaths. Nationally, one of every 10 nursing home residents have died.
But as first reported by The World-Herald in February, nursing home cases in Nebraska and across the United States plummeted after vaccinations were launched in December. By March, weekly resident cases and deaths in Nebraska care facilities had dropped to zero.
As the recent outbreak showed, however, COVID-19 has not completely disappeared from care facilities.
The World-Herald learned of the Kearney outbreak by monitoring a database of COVID-19 case reports that U.S. nursing homes file with federal regulators.
Nebraska state officials generally have declined to reveal nursing home outbreaks or release information on them.
But in response to questions, both HHS and St. Luke’s officials released some information on the Kearney outbreak. They declined to provide some details, saying to do so would risk releasing confidential medical information on residents or staff.
The outbreak in the home is thought to have begun April 2 when an unvaccinated staff member came to work while infectious.
Officials have not disclosed what percentage of the home’s staff or residents were vaccinated, though a spokesman for the home did say the number of unvaccinated residents was “very, very small.”
The virus behind the outbreak was identified as the U.K. variant. Studies have suggested that variant, which originated in the United Kingdom, is more contagious than earlier strains, and possibly more dangerous.
After the initial positive test, all residents and staff were tested. And by the time the outbreak was contained, 23 of the home’s 42 residents tested positive.
In the past, that likely would have spelled disaster.
Both nationally and in Nebraska, one in five nursing home residents who have tested positive eventually died.
But in the Kearney outbreak, state officials say that not only did no residents get seriously ill, only two showed any symptoms at all. In both cases, the symptoms were mild and quickly resolved.
Credit the vaccines, Ashraf said.
“That’s what we were expecting of the vaccines,” he said. “That’s reassuring.”
Federal data also indicate 12 of 50 staff members at the Kearney home tested positive in the outbreak. Officials did not given details on their vaccination levels or outcomes.
Ashraf said such big breakthrough outbreaks have been rare. Only two — Kearney and Kentucky — have been documented, but a World-Herald analysis of federal data suggests that there have been more.
During the past two months, 17 of the nation’s more than 15,000 federally licensed care facilities have reported outbreaks as big or bigger than the one in Kearney, the World-Herald analysis found. One of them was the March outbreak in Kentucky.
The CDC’s report on that outbreak did not identify the Kentucky home. But the federal database indicates the facility was in Morehead, Kentucky, a small city in the Appalachian foothills.
In the Kentucky outbreak, vaccinated residents didn’t fare as well as those in Kearney. Out of the home’s 71 vaccinated residents, 18 tested positive, six showed symptoms, two ended up in hospitals and one died. Still, that handful of sickened residents appears in line with the trial results finding the vaccines more than 90% effective.
For residents of the Kentucky home who failed to take the vaccine, the results in comparison were catastrophic.
Of the eight residents who had not received the shots, six tested positive for COVID, five showed symptoms, four were hospitalized and two died. To sum it up, the home’s unvaccinated residents were 18 times more likely to end up in the hospital and 18 times more likely to die than the vaccinated ones.
The CDC report said the Kentucky outbreak showed that if nursing home residents are to be protected, it’s imperative that both residents and staff be vaccinated. While almost 90% of residents in the Kentucky home were vaccinated, only about half of staff members were.
The report also noted that one of the residents who died had previously contracted the virus 300 days earlier. That underscores the importance of the current guidance that everyone — even those who have previously contracted COVID-19 — get the vaccines, the CDC said.
Ashraf said there’s definitely room for improvement in vaccination rates among Nebraska nursing home staff. He said he has seen homes with rates over 95% and others that struggle to get over 25%.
New federal guidelines handed down this week could provide more incentive for workers to get the shots.
Federal regulators last summer imposed stringent testing guidelines for nursing home workers. In communities with significant virus spread, workers have been required to test twice a week.
But under the new federal directive, workers who have been vaccinated can be exempted from the weekly testing as long as they aren’t showing symptoms of the virus.
Ashraf said he hopes the change will serve as incentive for more staff members to get vaccinated.
“For the maximum protection of the residents, we will need to have a higher percentage of residents and staff vaccinated,” he said. “I think there is a momentum toward more vaccinations. We can do much better.”