Colorado nursing homes continue to see COVID outbreaks, but deaths have become more rare

A sign on the door warned visitors of the COVID-19 outbreak within, but inside Parkview Care Center, life went on more or less as normal.

While residents of the Denver nursing home who tested positive had to isolate in their rooms, others wheeled around freely — albeit wearing marks — and gathered in small groups to talk or snack on the mini-cheesecakes and sopapillas that were left over from a roundtable with state and federal health officials.

U.S. Secretary of Health and Human Services Xavier Becerra was in Denver on Monday to talk about COVID-19 boosters, and stopped at Parkview because it achieved a high vaccination rate while serving primarily Latinos, who have been less likely to get the vaccine shots.

It’s a scene that wouldn’t have been possible earlier in the pandemic, both because federal and state rules have changed and because COVID-19 outbreaks are no longer as dangerous a threat, even in nursing homes. While clusters of cases are once again widespread, deaths from the virus have become significantly more rare, according to state data.

Even if there hadn’t been an ongoing outbreak, a gathering like Monday’s wouldn’t have been a good idea a year or two ago, said Doug Farmer, president and CEO of the Colorado Health Care Association.

“We probably wouldn’t have invited people into the building, for fear of a case shutting the whole building down,” he said.

“Or killing someone,” added Jay Moskowitz, president and CEO of Vivage Senior Living, which owns Parkview.

COVID-19 outbreaks returned this fall as cases rose in the community. They hit a low of 120 in nursing homes and assisted living facilities during the week of Nov. 2, then doubled to 240 the week of Dec. 7. As of Wednesday, 193 outbreaks were considered active.

The Colorado Department of Public Health and Environment no longer publishes the number of cases and deaths associated with outbreaks that are considered ongoing, meaning that the public only gets a sense of their severity multiple weeks after the spread has stopped. Still, it’s possible to see a significant change.

In the first three months of 2020, Colorado nursing homes and assisted living facilities averaged more than 40 cases and almost seven deaths in each reported outbreak. While the number of cases is still relatively high, averaging about 20 per outbreak in the first half of 2022, the average number of deaths has stayed below one per outbreak since the first quarter of 2021, when residents and staff started receiving vaccines.

About 90% of residents in Colorado nursing homes received their first two shots, and about 62% are up-to-date with their boosters, according to the Centers for Medicare and Medicaid Services. Nationwide, the averages are about 86% and 47%, respectively.

At Parkview, 97% of residents have had their first two shots, and 80% are up-to-date on boosters. Heather TerHark-Monreal, vice president of ancillary services at Vivage, said they hosted booster clinics earlier this fall to make it as convenient as possible for residents and staff members. The chain’s chief medical officer made himself available for one-on-one conversations with people who were uncertain about the shots, she said.

“Vaccines have to come to people,” she said.

People still at risk

Older people and those with chronic conditions remain at heightened risk from COVID-19, as well as from the resurgent flu and respiratory syncytial virus, or RSV. The COVID-19 hospitalization rate for people over 75 has risen about 49% since mid-November, while younger groups saw much smaller increases, according to data from the Centers for Disease Control and Prevention.

People over 65 are more likely to be up-to-date on their vaccines than younger people, but the majority still could be vulnerable. Only about 35% of that age group has gotten an updated booster nationwide, and about 49% has in Colorado.

Jayla Sanchez-Warren, director of the area agency on aging under the Denver Regional Council of Governments, said it remains a challenge getting all older people vaccinated, whether they live in facilities or in the community. Some people, particularly marginalized groups like older refugees, hesitated at first, while others are wondering why they need repeated doses, she said.

While uptake of the updated booster has been sluggish, early data suggests it does have a benefit in reducing severe disease, especially among older people.

A study including about 800 people over 65 found those who got an updated booster were about 73% less likely to be hospitalized than those who only had the original shots, and 84% less likely than those who were unvaccinated. It’s not clear how much of the advantage is due to the changed composition of the shots, and how much reflected that most older people had their original shots and boosters many months ago.

Nationwide, about 86% of nursing home workers had received their first two shots, and 22% were up-to-date. In Colorado, the averages were somewhat higher, with 91% receiving two doses and 38% up-to-date.

At Parkview, 99% of staff have gotten the first two shots, though only about 49% have had the latest booster. Becerra said part of his trip to Colorado was to get ideas for how to increase vaccination in other nursing homes. Incentives only go so far, so penalties may be necessary at some point, he said, without elaborating on what those might be.

“You don’t get to nearly 100% vaccination among your staff .. unless your team is committed to get it done,” Becerra said. “You can’t buy that.”

Community spread

The U.S. Department of Health and Human Services has asked nursing homes to offer booster shots to all residents, and allowed more workers in those facilities to give vaccines. It also requested that facilities connect residents to antiviral treatment if they test positive and try to improve their indoor air quality.